News: Study finds improved method for UTI, pneumonia antibiotic selection

Use of a computerized provider order entry (CPOE) prompt reduced the empiric use of extended-spectrum antibiotics in adults hospitalized for urinary tract infections (UTI) or pneumonia, according to a new study published in JAMA. The CPOE bundle resulted in a 17.4% reduction for the UTI trial, and a 28.4% reduction in the pneumonia trial, without significantly affecting the safety outcomes of days to intensive care unit transfer or hospital length of stay, MedPage Today reported.

The studies were conducted at a network of 59 community hospitals across the United States, which were randomized to use either routine antibiotic stewardship or the CPOE bundle over an 18-month baseline period, a six-month phase-in period, and a 15-month intervention period. Researchers compared routine stewardship with the CPOE bundle, which was composed of routine stewardship and CPOE prompts that recommended standard-spectrum instead of extended-spectrum antibiotics during the first three hospital days for patients with a low absolute risk (<10%) of multidrug-resistant organism infection.

“The right information at the right time can improve physician antibiotic selection,” said Shruti K. Gohil, MD, MPH, of the University of California Irvine School of Medicine, one of the study’s authors in a press release. “Many different bacteria can cause pneumonia or UTI, and picking the best matched antibiotic can be a challenge. Results from these trials show that giving physicians an alert informing them of their patient's actual risk for antibiotic resistance can help them choose the best antibiotic and reduce extended-spectrum antibiotic use.”

The study authors cautioned that integrating the intervention used in the trials into existing clinical workflows may be a challenge, considering strong support from leadership and collaboration among different groups of frontline clinicians would be required. Differing electronic health records across hospitals and health systems may also hinder widespread implementation.

Editor’s note: To read MedPage Today’s coverage of this story, click here. To access the JAMA study, click here.