Conditions

Urinary Tract Infection (UTI)

Keywords

UTICPOEEmpiric Therapy

Outcome Measures

Primary Outcomes (1)

Extended-Spectrum Days Of Antibacterial Therapy (ES-DOT) Per Empiric Day
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.
First 3 days of hospitalization for each patient during 15-month intervention period

Secondary Outcomes (2)

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

Other Outcomes (8)

Antibacterial Escalations [Safety Outcome 1]
15 month intervention
ICU Transfers [Safety Outcome 2]
15 month intervention
Length-of-stay [Safety Outcome 3]
15 month intervention
+5 more other outcomes

Study Arms (2)

Routine Care

ACTIVE COMPARATOR

Continued routine antibiotic stewardship strategies.

Other: Routine Care

INSPIRE CPOE Smart Prompt

ACTIVE COMPARATOR

Use of a computerized physician order entry (CPOE) smart prompt alert to guide empiric choice of antibiotics for UTI in non-ICU patients in the first 3 days of hospitalization.

Other: INSPIRE CPOE Smart Prompt

Interventions

Routine CareOther

Routine Antibiotic Stewardship Arm - Continuation of all antibiotic stewardship activities in accordance with national standards.

Routine Care

INSPIRE CPOE Smart PromptOther

Quality improvement intervention: computerized physician order entry (CPOE) decision support alert that provides physicians with patient-specific risk estimate of having a UTI due to a multidrug resistant organism (MDRO) and recommends appropriate antibiotic choice for non-ICU patients in the first 3 days of hospitalization. Continuation of other antibiotic stewardship activities in accordance with national standards.

Eligibility Criteria

Age18 Years+

Sexall

Healthy VolunteersNo

Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

HCA hospitals admitting adults for UTI
Facility use of MEDITECH as their electronic health record system

You may not qualify if:

Sponsors & Collaborators

Hospital Corporation of America
Industrycollaborator
University of California, Irvine
Othercollaborator
Harvard Pilgrim Health Care

Study Sites (59)

Riverside Community Hospital

Riverside, California, 92501, United States

Regional Medical Center of San Jose

San Jose, California, 95116, United States

Los Robles Regional Medical Center

Thousand Oaks, California, 91360, United States

The Medical Center of Aurora

Aurora, Colorado, 80012, United States

Swedish Medical Center

Denver, Colorado, 80113, United States

Sky Ridge Medical Center

Denver, Colorado, 80124, United States

Rose Medical Center

Denver, Colorado, 80220, United States

Related Publications (2)

Gohil SK, Septimus E, Kleinman K, Varma N, Avery TR, Heim L, Rahm R, Cooper WS, Cooper M, McLean LE, Nickolay NG, Weinstein RA, Burgess LH, Coady MH, Rosen E, Sljivo S, Sands KE, Moody J, Vigeant J, Rashid S, Gilbert RF, Smith KN, Carver B, Poland RE, Hickok J, Sturdevant SG, Calderwood MS, Weiland A, Kubiak DW, Reddy S, Neuhauser MM, Srinivasan A, Jernigan JA, Hayden MK, Gowda A, Eibensteiner K, Wolf R, Perlin JB, Platt R, Huang SS. Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial. JAMA. 2024 Jun 18;331(23):2018-2028. doi: 10.1001/jama.2024.6259.
PMID: 38639723RESULT
Gohil SK, Avery TR, Kleinman K, Septimus E, Mauricio A, Sands KE, Varma N, Sljivo S, Roemer K, Cooper WS, Poland RE, Weinstein RA, Fakhry SM, Guy J, Moody J, Coady MH, Smith-Sells KN, Hayden MK, Kubiak DW, Burks C, Platt R, Huang SS, Baker MA. Improving Empiric Antibiotic Selection for Patients With Cancer Hospitalized With Infection: Secondary Analysis of the INSPIRE Cluster Randomized Trials. JAMA Netw Open. 2026 Jun 1;9(6):e2616611. doi: 10.1001/jamanetworkopen.2026.16611.
PMID: 42268612

MeSH Terms

Conditions

Urinary Tract Infections

Condition Hierarchy (Ancestors)

InfectionsUrologic DiseasesFemale Urogenital DiseasesFemale Urogenital Diseases and Pregnancy ComplicationsUrogenital DiseasesMale Urogenital Diseases

Limitations and Caveats

\[Not Specified\]

Results Point of Contact

Title: Dr. Shruti Gohil, MD, MPH
Organization: Division of Infectious Diseases, University of California Irvine School of Medicine

Study Officials

Shruti Gohil, MD, MPH
UC Irvine Div Infectious Diseases
STUDY DIRECTOR
Susan Huang, MD, MPH
UC Irvine Div Infectious Diseases
PRINCIPAL INVESTIGATOR
Richard Platt, MD, MS
Harvard Pilgrim Health Care Institute
PRINCIPAL INVESTIGATOR

Publication Agreements

PI is Sponsor Employee: No
Restrictive Agreement: No

Brief Summary

Registry Overview

Trial Relationships

Related Scientific Literature

Study Timeline

Study Start

First Submitted

First Posted

Primary Completion

Study Completion

Results Posted

Conditions

Keywords

Outcome Measures

Primary Outcomes (1)

Secondary Outcomes (2)

Other Outcomes (8)

Study Arms (2)

Routine Care

INSPIRE CPOE Smart Prompt

Interventions

Eligibility Criteria

You may qualify if:

You may not qualify if:

Sponsors & Collaborators

Study Sites (59)

Related Publications (2)

Related Links

MeSH Terms

Conditions

Condition Hierarchy (Ancestors)

Limitations and Caveats

Results Point of Contact

Study Officials

Publication Agreements

Enrollment

Study Design

Study Record Dates

Data Sharing

Source record

Documents

Locations