Large-Scale Studies Find Effective Strategy to Improve Antibiotic Use in Hospitals
Two extensive multi-state studies funded by the National Institutes of Health and led by the University of California, Irvine, Harvard Pilgrim Health Care Institute, and HCA Healthcare have uncovered a highly effective method to optimize antibiotic prescriptions for hospitalized patients with abdominal or skin and soft tissue infections. The results, published in JAMA Surgery and JAMA Internal Medicine, were also presented at the European Congress of Clinical Microbiology and Infectious Diseases.
Addressing a Growing Threat
Antibiotic resistance is a critical public health concern, complicating treatments and increasing risks during surgeries. According to the CDC, over 2.8 million antibiotic-resistant infections occur annually in the U.S., while the WHO reported 1.27 million deaths linked to antibacterial resistance in 2019. Improving how antibiotics are prescribed can protect patients by preserving healthy bacteria and minimizing risks such as organ toxicity and C. difficile infection.
How the Trials Worked
The two INSPIRE Trials enrolled more than 316,000 patients across 92 HCA Healthcare hospitals. Half of the hospitals used a system that issued real-time computerized alerts when antibiotics were prescribed, suggesting the best antibiotic based on each patient’s medical records and local resistance patterns.
These alerts significantly improved antibiotic selection—by 35% for abdominal infections and 28% for skin and soft tissue infections—compared to hospitals that did not use the alerts. The system helped identify patients at low risk for resistant bacteria and prompted physicians to consider using standard-spectrum antibiotics instead of unnecessarily broad-spectrum ones.
Building on Previous Success
The research builds on prior INSPIRE trials that focused on pneumonia and urinary tract infections. Together, these studies cover the four most common infections requiring hospitalization and demonstrate how electronic health data can enhance antibiotic stewardship.
Nationwide Impact
The trials involved community hospitals in 15 states, suggesting broad applicability. HCA Healthcare is expanding the use of these alerts across its 190 hospitals.
“Providing physicians with real-time data on antibiotic resistance risk enables better treatment decisions,” said Dr. Shruti Gohil, Associate Professor of Infectious Diseases at UC Irvine. “These results show that we can reduce unnecessary use of extended-spectrum antibiotics with the right tools.”
Dr. Kenneth Sands, Chief Epidemiologist at HCA Healthcare, added: “Our scale and data ecosystem allow us to answer critical clinical questions. These findings support better antibiotic stewardship and help combat resistance.”
The studies were the result of a long-term collaboration between HCA Healthcare, Harvard Pilgrim Health Care Institute, and UC Irvine.
About HCA Healthcare
Nashville-based HCA Healthcare is one of the nation’s leading providers of healthcare services comprising 190 hospitals and approximately 2,400 ambulatory sites of care, including surgery centers, freestanding ERs, urgent care centers, and physician clinics, in 20 states and the United Kingdom. With its founding in 1968, HCA Healthcare created a new model for hospital care in the United States, using combined resources to strengthen hospitals, deliver patient-focused care and improve the practice of medicine. HCA Healthcare has conducted a number of clinical studies, including one that demonstrated that full-term delivery is healthier than early elective delivery of babies and another that identified a clinical protocol that can reduce bloodstream infections in ICU patients by 44%. HCA Healthcare is a learning health system that uses its approximately 44 million annual patient encounters to advance science, improve patient care and save lives.
About UCI Health
UCI Health, one of California’s largest academic health systems, is the clinical enterprise of the University of California, Irvine. The 1,317-bed system comprises its main campus UCI Medical Center, its flagship hospital in Orange, Calif., the UCI Health — Irvine medical campus, four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and a network of ambulatory care centers across the region. UCI Medical Center provides tertiary and quaternary care and is home to the only Orange County-based National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. Powered by UC Irvine, UCI Health serves nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.
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 the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Point32Health is the parent company of Harvard Pilgrim Health Care and Tufts Health Plan.
