# INSPIRE (INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection for Patients): The INSPIRE-ASP Trial for Intra-Abdominal and Skin and Soft Tissue Infections

> **NIH NIH U01** · HARVARD PILGRIM HEALTH CARE, INC. · 2024 · $1,499,671

## Abstract

Abstract
The INSPIRE-ASP Trial (INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic
Selection for Patients) for Abdominal and Skin and Soft Tissue Infections
 The INSPIRE-ASP Trial (INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic
Selection for Patients) for Abdominal and Skin and Soft Tissue Infections is a cluster-randomized trial to
improve judicious antibiotic prescribing for non-critically ill hospitalized patients with abdominal infections or
skin and soft tissue infections. Currently, over half of non-critically ill patients with one of these infections
receive extended-spectrum antibiotics when less than 5% have an antibiotic-resistant pathogen. The goal of
this trial is to advise physicians to prescribe standard- vs extended spectrum empiric antibiotics based on an
algorithm that estimates each patient’s personalized probability of having an antibiotic-resistant infection. This
personalized probability is based upon routinely-collected patient information in the electronic health record
and local prevalence of resistant organisms in abdominal or skin and soft tissue infections.
 This trial will compare routine care under hospital-based antibiotic stewardship programs to the
enhanced program using the predictive algorithm plus audit and feedback to reduce unnecessary empiric
prescribing of extended-spectrum antibiotics. In our first aim, we will develop disease-specific prediction
algorithms for abdominal infections and for skin and soft tissue infections. In our second aim, this predictive
algorithm will be integrated into the computerized provider order entry (CPOE) system to prompt physicians
when selected antibiotics are discordant with the estimated need for that antibiotic. Physicians will be prompted
to use standard-spectrum antibiotics when the risk of an antibiotic-resistant infection is low. Sixty hospitals will
be randomized to either routine care or the CPOE prompt intervention plus feedback. This 18-month study will
evaluate ~53,000 patients with abdominal infections and ~37,000 patients with skin and soft tissue infections.
 This trial will evaluate the ability of a real-time risk calculator plus audit and feedback to reduce
unnecessary extended-spectrum antibiotics while maintaining good clinical outcomes as measured by length-
of-stay and transfer to an intensive care unit. These methods will be readily applicable to other electronic
health record prescribing systems.

## Key facts

- **NIH application ID:** 10840313
- **Project number:** 5U01AI153005-05
- **Recipient organization:** HARVARD PILGRIM HEALTH CARE, INC.
- **Principal Investigator:** Susan S. Huang
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $1,499,671
- **Award type:** 5
- **Project period:** 2020-06-19 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10840313

## Citation

> US National Institutes of Health, RePORTER application 10840313, INSPIRE (INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection for Patients): The INSPIRE-ASP Trial for Intra-Abdominal and Skin and Soft Tissue Infections (5U01AI153005-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10840313. Licensed CC0.

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