Two Large Clinical Trials Find a Highly Effective Method to Select Appropriate Antibiotics for Patients Hospitalized With Abdominal or Skin and Soft Tissue Infection
Two major clinical trials across 92 HCA Healthcare hospitals have demonstrated a breakthrough in improving antibiotic selection for hospitalized patients with abdominal or skin/soft tissue infections. The studies, involving over 316,000 patients, showed that computerized alerts helping clinicians choose appropriate antibiotics resulted in a 35% improvement in antibiotic selection for abdominal infections and a 28% improvement for skin/soft tissue infections.
The system uses patient-specific data from electronic medical records and hospital data to assess the risk of antibiotic-resistant infections. For low-risk patients, physicians were prompted to switch from broad-spectrum antibiotics to standard-spectrum alternatives. The research was based on pre-trial data from over 420,000 HCA Healthcare patients.
These INSPIRE trials address two of the four most common infections requiring hospitalization. HCA Healthcare is now implementing these protocols across its 190 hospitals, potentially improving care for millions of U.S. patients while helping combat the growing threat of antibiotic resistance.
Due importanti studi clinici condotti in 92 ospedali HCA Healthcare hanno dimostrato un progresso significativo nel migliorare la selezione degli antibiotici per i pazienti ricoverati con infezioni addominali o della pelle/tessuti molli. Gli studi, che hanno coinvolto oltre 316.000 pazienti, hanno mostrato che gli avvisi computerizzati che aiutano i clinici a scegliere gli antibiotici appropriati hanno portato a un 35% di miglioramento nella selezione degli antibiotici per le infezioni addominali e a un 28% di miglioramento per le infezioni della pelle/tessuti molli.
Il sistema utilizza dati specifici del paziente provenienti da cartelle cliniche elettroniche e dati ospedalieri per valutare il rischio di infezioni resistenti agli antibiotici. Per i pazienti a basso rischio, i medici sono stati invitati a passare da antibiotici ad ampio spettro a alternative a spettro standard. La ricerca si basava su dati pre-studio di oltre 420.000 pazienti HCA Healthcare.
Questi studi INSPIRE affrontano due delle quattro infezioni più comuni che richiedono ospedalizzazione. HCA Healthcare sta ora implementando questi protocolli in tutti i suoi 190 ospedali, migliorando potenzialmente le cure per milioni di pazienti negli Stati Uniti e contribuendo a combattere la crescente minaccia della resistenza agli antibiotici.
Dos ensayos clínicos importantes realizados en 92 hospitales de HCA Healthcare han demostrado un avance significativo en la mejora de la selección de antibióticos para pacientes hospitalizados con infecciones abdominales o de piel/tejidos blandos. Los estudios, que involucraron a más de 316,000 pacientes, mostraron que las alertas computarizadas que ayudan a los clínicos a elegir los antibióticos apropiados resultaron en una mejora del 35% en la selección de antibióticos para infecciones abdominales y una mejora del 28% para infecciones de piel/tejidos blandos.
El sistema utiliza datos específicos del paciente de registros médicos electrónicos y datos hospitalarios para evaluar el riesgo de infecciones resistentes a los antibióticos. Para los pacientes de bajo riesgo, se instó a los médicos a cambiar de antibióticos de amplio espectro a alternativas de espectro estándar. La investigación se basó en datos previos al ensayo de más de 420,000 pacientes de HCA Healthcare.
Estos ensayos INSPIRE abordan dos de las cuatro infecciones más comunes que requieren hospitalización. HCA Healthcare está implementando ahora estos protocolos en sus 190 hospitales, mejorando potencialmente la atención para millones de pacientes en EE. UU. mientras ayuda a combatir la creciente amenaza de la resistencia a los antibióticos.
92개의 HCA Healthcare 병원에서 진행된 두 개의 주요 임상 시험이 복부 또는 피부/연조직 감염으로 입원한 환자에 대한 항생제 선택 개선의 획기적인 진전을 보여주었습니다. 316,000명 이상의 환자가 참여한 연구에서, 임상 의사들이 적절한 항생제를 선택하는 데 도움을 주는 컴퓨터 경고가 복부 감염에 대한 항생제 선택에서 35% 개선을, 피부/연조직 감염에서는 28% 개선을 가져왔습니다.
이 시스템은 전자 의료 기록과 병원 데이터를 기반으로 환자별 데이터를 사용하여 항생제 내성 감염의 위험을 평가합니다. 저위험 환자의 경우, 의사들은 광범위 항생제에서 표준 스펙트럼 대안으로 전환하도록 권장받았습니다. 연구는 420,000명 이상의 HCA Healthcare 환자에 대한 사전 시험 데이터를 기반으로 했습니다.
이 INSPIRE 시험은 입원이 필요한 네 가지 가장 일반적인 감염 중 두 가지를 다룹니다. HCA Healthcare는 이제 이 프로토콜을 190개 병원에 걸쳐 시행하고 있으며, 이는 미국의 수백만 환자에게 치료를 개선하고 항생제 내성의 증가하는 위협에 대응하는 데 기여할 수 있습니다.
Deux grandes études cliniques menées dans 92 hôpitaux HCA Healthcare ont démontré une avancée significative dans l'amélioration du choix des antibiotiques pour les patients hospitalisés souffrant d'infections abdominales ou de la peau/des tissus mous. Les études, impliquant plus de 316 000 patients, ont montré que des alertes informatisées aidant les cliniciens à choisir les antibiotiques appropriés ont entraîné une amélioration de 35% dans le choix des antibiotiques pour les infections abdominales et une amélioration de 28% pour les infections de la peau/des tissus mous.
Le système utilise des données spécifiques au patient provenant des dossiers médicaux électroniques et des données hospitalières pour évaluer le risque d'infections résistantes aux antibiotiques. Pour les patients à faible risque, les médecins ont été incités à passer d'antibiotiques à large spectre à des alternatives à spectre standard. La recherche était basée sur des données préliminaires de plus de 420 000 patients de HCA Healthcare.
Ces essais INSPIRE traitent de deux des quatre infections les plus courantes nécessitant une hospitalisation. HCA Healthcare met désormais en œuvre ces protocoles dans ses 190 hôpitaux, améliorant potentiellement les soins pour des millions de patients aux États-Unis tout en contribuant à lutter contre la menace croissante de la résistance aux antibiotiques.
Zwei wichtige klinische Studien, die an 92 HCA Healthcare-Krankenhäusern durchgeführt wurden, haben einen Durchbruch bei der Verbesserung der Antibiotikawahl für hospitalisierte Patienten mit Bauch- oder Haut-/Weichgewebeinfektionen gezeigt. Die Studien, an denen über 316.000 Patienten beteiligt waren, zeigten, dass computerisierte Warnungen, die Kliniker bei der Auswahl geeigneter Antibiotika unterstützen, zu einer 35%igen Verbesserung bei der Antibiotikawahl für Bauchinfektionen und einer 28%igen Verbesserung für Haut-/Weichgewebeinfektionen führten.
Das System nutzt patientenspezifische Daten aus elektronischen Patientenakten und Krankenhausdaten, um das Risiko von antibiotikaresistenten Infektionen zu bewerten. Bei Patienten mit niedrigem Risiko wurden die Ärzte aufgefordert, von Breitbandantibiotika auf Standard-Spektrum-Alternativen umzusteigen. Die Forschung basierte auf Daten vor der Studie von über 420.000 HCA Healthcare-Patienten.
Diese INSPIRE-Studien befassen sich mit zwei der vier häufigsten Infektionen, die eine Hospitalisierung erfordern. HCA Healthcare setzt diese Protokolle nun in seinen 190 Krankenhäusern um, was potenziell die Versorgung von Millionen von Patienten in den USA verbessert und gleichzeitig hilft, der wachsenden Bedrohung durch Antibiotikaresistenzen entgegenzuwirken.
- Significant improvement in antibiotic selection: 35% for abdominal infections and 28% for skin/soft tissue infections
- Large-scale implementation potential across 190 HCA Healthcare hospitals
- System successfully reduces unnecessary use of broad-spectrum antibiotics
- Robust study with large sample size (316,000+ patients) across 92 hospitals in 15 states
- None.
Insights
The successful completion of two large-scale clinical trials across 92 HCA Healthcare hospitals represents a significant operational advancement for the company. These INSPIRE trials, involving over 316,000 patients, demonstrated substantial improvements in antibiotic selection—
This implementation has strategic implications for HCA's operations across its entire 190-hospital network. The company is already rolling out these protocols system-wide, positioning it to capture several operational benefits:
- Reduced complication rates from antibiotic-resistant infections
- Lower costs associated with extended hospital stays due to treatment failures
- Decreased risk of C. difficile infections and other antibiotic-related adverse events
- Enhanced compliance with treatment guidelines from the Infectious Diseases Society of America
The scale of these trials—spanning 15 states within HCA's network—demonstrates the company's unique ability to leverage its size and integrated data systems to drive clinical improvements. This represents a competitive advantage over smaller healthcare systems that lack comparable data infrastructure or implementation capabilities.
These results build upon HCA's previous successful implementation of similar protocols for pneumonia and urinary tract infections, showing a systematic approach to addressing the four most common infections requiring hospitalization. By improving antibiotic stewardship across its entire system, HCA is likely to see improved clinical outcomes and operational efficiency while addressing a major public health concern.
The clinical significance of HCA Healthcare's antibiotic stewardship initiative cannot be overstated. These trials address a critical challenge in modern medicine—the growing threat of antimicrobial resistance that leads to 2.8 million resistant infections annually in the U.S. alone.
What makes this approach particularly valuable is its targeted precision. Rather than implementing blanket restrictions on broad-spectrum antibiotics, the system uses patient-specific risk factors and local resistance patterns to guide appropriate prescribing. The methodology is sound—risk assessments were developed using data from 420,000+ previous HCA patients with these infections.
The results show meaningful clinical improvements over standard prescribing practices. By focusing interventions on patients at low risk for resistant organisms, the system avoids undermining treatment for high-risk patients while significantly reducing unnecessary broad-spectrum antibiotic use.
This represents the completion of a comprehensive antibiotic stewardship program covering the four infection types that drive most broad-spectrum antibiotic use in hospitals. The real-world implementation across such a diverse hospital network demonstrates scalability beyond academic medical centers.
From a public health perspective, the size and diversity of HCA's hospital network make these findings particularly robust. Community hospitals represent the majority of U.S. inpatient care, and demonstration of success in this setting suggests broad applicability nationwide. This initiative addresses a key recommendation from major infectious disease societies to improve antibiotic selection while maintaining effective treatment, potentially slowing the development of resistance while reducing adverse events like C. difficile infections.
Computerized alerts tailored to each patient help identify which antibiotic is best suited to treat patients hospitalized with common infections in two 92-hospital trials.
Antibiotic resistance is a major public health threat. It makes infections harder to treat and adds additional risk to surgery and other procedures. The Centers for Disease Control & Prevention estimates that more than 2.8 million infections with antibiotic-resistant bacteria occur in the
The two newly published studies, the INSPIRE Abdominal and Skin & Soft Tissue Trials, involved more than 316,000 patients in 92 HCA Healthcare hospitals. In half of the hospitals, clinicians were given computerized alerts with information about the best antibiotic match for an individual patient with abdominal or skin/soft tissue infection at the moment antibiotics were ordered. This resulted in a
The alerts were informed by patient characteristics from the electronic medical record as well as hospital-specific data to determine the patient’s risk for an antibiotic-resistant infection. Assessment of risk was based on pre-trial data from more than 420,000 HCA Healthcare patients with abdominal or skin and soft tissue infections. Physicians treating patients with a low risk for antibiotic-resistant bacteria were prompted to switch to standard-spectrum antibiotics if they initially selected unnecessary broad-spectrum drugs.
This investigative team previously published results from another set of two trials that improved antibiotic selection in patients with pneumonia and urinary tract infection. Together, these INSPIRE studies represent the four most common infections requiring hospitalization that drive overuse of broad-spectrum antibiotics and show the value of harnessing electronic health data to improve best practice. These findings have the potential to improve care for millions of patients hospitalized with infections in the
Physicians often choose extended-spectrum antibiotics that treat a very broad range of bacteria out of concern that their patients could be infected by antibiotic-resistant bacteria. The INSPIRE Trials identified patients with low risk for antibiotic resistance and prompted physicians to consider changing to standard-spectrum antibiotics if extended-spectrum antibiotics were being ordered. The trials found that giving physicians real-time information about their patients’ risk for antibiotic resistance worked significantly better to align antibiotic prescribing with current Infectious Diseases Society of America treatment recommendations.
“The right information at the right time can improve physician antibiotic selection,” said Shruti Gohil, MD, MPH, Associate Professor in the Division of Infectious Diseases at the University of
The 92 participating community hospitals spanned 15 states and are part of HCA Healthcare, one of the largest private inpatient healthcare systems in the
“HCA Healthcare is committed to using our scale and data ecosystem to answer important clinical questions that benefit patients,” said Kenneth Sands, MD, MPH, chief epidemiologist at HCA Healthcare. “The ability to identify patients at low-risk for antibiotic resistance to limit the overall use of wide-spectrum antibiotics can help hospitals improve antibiotic stewardship efforts and curb resistance.”
The studies were conducted through a longstanding scientific collaboration including HCA Healthcare, Harvard Pilgrim Health Care Institute, and the University of
Additional information about the INSPIRE Abdominal and Skin/Soft Tissue Trials can be found at:
Editorial: Electronic Stewardship Prompts — Exploring the Why Behind the What
About HCA Healthcare
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About Harvard Pilgrim Healthcare Institute’s Department of Population Medicine
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in
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Source: HCA Healthcare
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