Improving Empiric Antibiotic Selection for Patients With Cancer Hospitalized With Infection

Can computerized provider order entry (CPOE) prompts with patient-specific risk estimates for multidrug-resistant organisms (MDROs) safely reduce the use of empiric extended-spectrum antibiotics in patients with cancer hospitalized with infection?This secondary analysis of 4 cluster randomized clinical trials evaluating CPOE prompts (plus education and feedback) promoting standard-spectrum antibiotics in patients with low MDRO infection risk found that empiric extended-spectrum antibiotic days of therapy decreased by 17% to 27%, without evidence of inferiority in intensive care unit transfers or length of stay.This study’s results suggest that CPOE-generated recommendations based on patient-specific risk for MDRO-associated pneumonia, urinary tract infections, skin or soft tissue infection, and abdominal infections may substantially and safely reduce the use of empiric extended-spectrum antibiotics in patients with cancer hospitalized for infection.

Corresponding Author: Shruti K. Gohil, MD, MPH, School of Medicine, University of California, Irvine, 100 Theory, Ste 120, Irvine, CA 92617 (skgohil@hs.uci.edu).

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