{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:20:29Z","timestamp":1791645629886,"version":"4.3.4"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>Empiric extended-spectrum antibiotics are routinely prescribed for over a million patients hospitalized annually with abdominal infection despite low likelihoods of infection with multidrug-resistant organisms (MDROs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates can reduce empiric extended-spectrum antibiotics for non\u2013critically ill patients admitted with abdominal infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This 92-hospital cluster randomized clinical trial assessed the effect of an antibiotic stewardship bundle with CPOE prompts vs routine stewardship on antibiotic selection during the first 3 hospital days (empiric period) in non\u2013critically ill adults hospitalized with abdominal infection. The trial population included adults (\u226518 years) treated with empiric antibiotics for abdominal infection in non\u2013intensive care units (ICUs). The trial periods included a 12-month baseline from January to December 2019 and an intervention period from January to December 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>CPOE prompts recommending standard-spectrum antibiotics in patients prescribed extended-spectrum antibiotics during the empiric period if the patient\u2019s estimated absolute risk of MDRO abdominal infection was less than 10%, coupled with feedback and education.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was empiric extended-spectrum antibiotic days of therapy. Safety outcomes: days to ICU transfer and hospital length of stay. Analyses compared differences between baseline and intervention periods across strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 92 hospitals with 198\u202f480 patients, mean (SD) age was 60 (19) years and 118\u202f723 (59.8%) were female. The trial included 93\u202f476 and 105\u202f004 patients hospitalized with abdominal infection during the baseline and intervention periods, respectively. Receipt of any empiric extended-spectrum antibiotics for the routine care group was 48.2% (22 519 of 46\u202f725) during baseline and 50.5% (27\u202f452 of 54\u202f384) during intervention vs 47.8% (22 367 of 46\u202f751) and 37.6% (19 010 of 50\u202f620) for the CPOE bundle group. The group receiving CPOE prompts had a 35% relative reduction (rate ratio, 0.65; 95% CI, 0.60-0.71; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) in empiric extended-spectrum antibiotic days of therapy vs routine care (raw absolute reduction between baseline and intervention periods was \u2212169 for the CPOE bundle vs \u221220 for routine care). Hospital length of stay was noninferior to routine care (0.1 days longer during intervention; mean [SD], baseline, 5.4 [3.4] days vs intervention, 5.5 [3.5] days; hazard ratio [HR], 1.02; 90% CI, 0.99-1.06), and mean days to ICU transfer in the CPOE group was indeterminate (both groups 0.2 days longer during intervention; HR, 1.10; 90% CI, 0.99-1.23).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>CPOE prompts recommending empiric standard-spectrum antibiotics (coupled with education and feedback) for patients admitted with abdominal infection who have low risk for MDRO infection significantly reduced extended-spectrum antibiotics without increasing ICU transfers or length of stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\/study\/NCT05423743\">NCT05423743<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2025.1108","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T11:00:39Z","timestamp":1744282839000},"page":"733","source":"Crossref","is-referenced-by-count":15,"title":["Improving Empiric Antibiotic Selection for Patients Hospitalized With Abdominal Infection"],"prefix":"10.1001","volume":"160","author":[{"given":"Shruti K.","family":"Gohil","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Septimus","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, 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