INSPIRE 3
Trial question
What is the role of computerized provider order entry stewardship bundle in noncritically ill patients hospitalized with SSTIs?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 60725
60725 patients (25731 female, 34994 male).
Inclusion criteria: noncritically ill adult patients hospitalized with SSTIs.
Key exclusion criteria: age < 18 years; ordered to receive extended-spectrum antibiotics for SSTI.
Interventions
N=29338 CPOE stewardship bundle (computerized patients order entry prompts recommending standard-spectrum antibiotics coupled with clinician education and feedback).
N=31337 routine stewardship (education materials and quarterly coaching calls to maintain stewardship activities per national guidelines).
Primary outcome
Reduction in empiric extended-spectrum antibiotic days of therapy
137.1
22.8
137.1 days p...
102.8 days p...
68.5 days p...
34.3 days p...
0.0 days p...
CPOE stewardship
bundle
Routine
stewardship
Significant
increase ▲
Significantly greater reduction in empiric extended-spectrum antibiotic days of therapy (137.1 days per 1,000 empiric days vs. 22.8 days per 1000 empiric days; RR 1.39, 95% CI 1.26 to 1.49).
Secondary outcomes
Significantly greater reduction in antipseudomonal days of therapy (132.6 days per 1,000 empiric days vs. 25.6 days per 1000 empiric days; RR 1.39, 95% CI 1.26 to 0.66).
Significantly greater reduction in vancomycin days of therapy (71.6 days per 1,000 empiric days vs. 16 days per 1000 empiric days; RR 1.11, 95% CI 1.05 to 1.16).
Safety outcomes
No significant differences in length of stay, days to ICU transfers.
Conclusion
In noncritically ill adult patients hospitalized with SSTIs, CPOE stewardship bundle was superior to routine stewardship with respect to reduction in empiric extended-spectrum antibiotic days of therapy.
Reference
Shruti K Gohil, Edward Septimus, Ken Kleinman et al. Improving Empiric Antibiotic Selection for Patients Hospitalized With Skin and Soft Tissue Infection: The INSPIRE 3 Skin and Soft Tissue Randomized Clinical Trial. JAMA Intern Med. 2025 Apr 10:e250887. Online ahead of print.
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