INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection for Patients With Urinary Tract Infections (UTI)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 55,412
- 试验地点
- 118
- 主要终点
- Extended-Spectrum Days Of Antibacterial Therapy (ES-DOT) Per Empiric Day
研究概览
简要总结
The INSPIRE-ASP UTI trial is a cluster-randomized controlled trial of HCA hospitals comparing routine empiric antibiotic stewardship practices with real-time precision medicine computerized physician order entry smart prompts providing the probability that a non-critically ill adult admitted with UTI is infected with a resistant pathogen.
Note: that enrolled "subjects" represents 59 individual HCA hospitals that have been randomized.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •HCA hospitals admitting adults for UTI
- •Facility use of MEDITECH as their electronic health record system
排除标准
- •Note: unit of randomization is the hospital, however the CPOE alert intervention will calculate risk estimates for adults age >=18 admitted to non-ICU wards and who are ordered to receive extended-spectrum antibiotics for UTI. Prisoners were excluded from prompts and analysis.
结局指标
主要结局
Extended-Spectrum Days Of Antibacterial Therapy (ES-DOT) Per Empiric Day
时间窗: First 3 days of hospitalization for each patient during 15-month intervention period
The number of different extended-spectrum antibacterials received by the patient each empiric day-of-therapy (outcome measure unit), averaged over the empiric days (the first 3 days of hospitalization), summed across all participants. Note that Days-of-Therapy unit is a standardized national measure for antibacterial use in hospitals. For clarity the calculation is as follows: we define a DOT for a particular ES antibiotic as a day in which any number of doses of that antibiotic is given. Different ES antibiotics are summed across the empiric days for each patient admission, then divided by the empiric days for that patient-admission to determine each admission's DOT per at-risk day. If an admission is less than 3 days, only the number of days the patient is admitted will contribute to the numerator and denominator.
次要结局
- Vancomycin Days of Antibacterial Therapy Per Empiric Day(First 3 days of hospitalization for each patient during 15-month intervention period)
- Antipseudomonal Antibiotic Days Of Therapy (ES-DOT) Per Empiric Day(First 3 days of hospitalization for each patient during 15-month intervention period)
研究者
Richard Platt
Professor and Chair, Department of Population Medicine
Harvard Pilgrim Health Care