INSPIRE Trial for Skin and Soft Tissue Infections

NCT ID: NCT05423756

Last Updated: 2025-08-26

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

118562 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-01-01

Study Completion Date

2024-05-09

Brief Summary

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The INSPIRE Skin and Soft Tissue Infection trial is a cluster-randomized controlled trial of HCA Healthcare hospitals comparing routine empiric antibiotic stewardship practices with real-time, precision medicine computerized physician order entry (CPOE) smart prompts providing the probability that a non-critically ill adult admitted with skin and soft tissue infection is infected with a resistant pathogen.

Note: enrolled "subjects" represent 102 individual HCA Healthcare hospitals that have been randomized into 92 clusters. Hospitals were grouped into the same randomization cluster if they shared campuses or antibiotic stewardship staff.

Detailed Description

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Conditions

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Skin and Soft Tissue (SST) Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Cluster randomized controlled trial
Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Arm 1: Routine Care

Continuation of routine antibiotic stewardship strategies.

Group Type ACTIVE_COMPARATOR

Arm 1: Routine Care

Intervention Type OTHER

Routine Antibiotic Stewardship Arm - Continuation of antibiotic stewardship activities in accordance with national standards.

Arm 2: INSPIRE Stewardship Bundle

Use of computerized physician order entry (CPOE) smart prompts, clinician feedback, and activities to support CPOE adoption (including education and alignment of CPOE workflows) to guide empiric choice of antibiotics for skin/soft tissue infection in the first 3 days of hospitalization.

Group Type ACTIVE_COMPARATOR

Arm 2: INSPIRE Stewardship Bundle for Skin and Soft Tissue Infection

Intervention Type OTHER

Quality improvement intervention that includes (1) computerized physician order entry (CPOE) decision support alert that provides physicians with patient-specific risk estimates for having a skin/soft tissue infection due to a multidrug-resistant organism (MDRO) and recommends standard spectrum antibiotics for low risk patients in the first 3 days of hospitalization; (2) clinician feedback reports, and (3) activities to support CPOE adoption (including education and alignment of CPOE workflows). Other antibiotic stewardship activities to continue in accordance with national standards.

Interventions

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Arm 1: Routine Care

Routine Antibiotic Stewardship Arm - Continuation of antibiotic stewardship activities in accordance with national standards.

Intervention Type OTHER

Arm 2: INSPIRE Stewardship Bundle for Skin and Soft Tissue Infection

Quality improvement intervention that includes (1) computerized physician order entry (CPOE) decision support alert that provides physicians with patient-specific risk estimates for having a skin/soft tissue infection due to a multidrug-resistant organism (MDRO) and recommends standard spectrum antibiotics for low risk patients in the first 3 days of hospitalization; (2) clinician feedback reports, and (3) activities to support CPOE adoption (including education and alignment of CPOE workflows). Other antibiotic stewardship activities to continue in accordance with national standards.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. HCA Healthcare hospitals admitting adults for skin and soft tissue infection
2. Facility use of MEDITECH as their electronic health record system

Exclusion Criteria

\-

Note: unit of randomization is the hospital, however the computerized physician order entry (CPOE) alert intervention will calculate risk estimates for adults age \>=18 admitted to non-intensive care unit wards and who are ordered to receive extended-spectrum antibiotics for skin and soft tissue infection.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Corporation of America

INDUSTRY

Sponsor Role collaborator

University of California, Irvine

OTHER

Sponsor Role collaborator

University of Massachusetts, Amherst

OTHER

Sponsor Role collaborator

Brigham and Women's Hospital

OTHER

Sponsor Role collaborator

Rush University

OTHER

Sponsor Role collaborator

Harvard Pilgrim Health Care

OTHER

Sponsor Role lead

Responsible Party

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Richard Platt

MD, MSc, Professor and Chair, Department of Population Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Shruti Gohil, MD, MPH

Role: STUDY_DIRECTOR

UC Irvine Division of Infectious Diseases

Susan Huang, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

UC Irvine Division of Infectious Diseases

Richard Platt, MD, MS

Role: PRINCIPAL_INVESTIGATOR

Harvard Pilgrim Health Care Institute/Harvard Medical School

Locations

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Wesley Medical Center

Wichita, Kansas, United States

Site Status

Riverside Community hospital

Riverside, California, United States

Site Status

Regional Medical Center of San Jose

San Jose, California, United States

Site Status

Good Samaritan Hospital

San Jose, California, United States

Site Status

Los Robles Hospital & Medical Center

Thousand Oaks, California, United States

Site Status

West Hills Hospital & Medical Center

West Hills, California, United States

Site Status

The Medical Center of Aurora

Aurora, Colorado, United States

Site Status

Swedish Medical Center

Englewood, Colorado, United States

Site Status

Sky Ridge Medical Center

Lone Tree, Colorado, United States

Site Status

North Suburban Medical Center

Thornton, Colorado, United States

Site Status

Blake Medical Center

Bradenton, Florida, United States

Site Status

Brandon Regional Hospital

Brandon, Florida, United States

Site Status

Oak Hill Hospital

Brooksville, Florida, United States

Site Status

Englewood Community Hospital

Englewood, Florida, United States

Site Status

Fort Walton Beach Medical Center

Fort Walton Beach, Florida, United States

Site Status

Lawnwood Regional Medical Center

Ft. Pierce, Florida, United States

Site Status

Regional Medical Center Bayonet Point

Hudson, Florida, United States

Site Status

Memorial Hospital Jacksonville

Jacksonville, Florida, United States

Site Status

Lake City Medical Center

Lake City, Florida, United States

Site Status

Largo Medical Center

Largo, Florida, United States

Site Status

Northwest Medical Center

Margate, Florida, United States

Site Status

Mercy Hospital

Miami, Florida, United States

Site Status

Kendall Regional Medical Center

Miami, Florida, United States

Site Status

Orange Park Medical Center

Orange Park, Florida, United States

Site Status

Oviedo Medical Center

Oviedo, Florida, United States

Site Status

Gulf Coast Regional Medical Center

Panama City, Florida, United States

Site Status

Fawcett Memorial Hospital

Port Charlotte, Florida, United States

Site Status

St. Lucie Medical Center

Port Saint Lucie, Florida, United States

Site Status

Doctors Hospital of Sarasota

Sarasota, Florida, United States

Site Status

Palms of Pasadena

St. Petersburg, Florida, United States

Site Status

Northside Hospital

St. Petersburg, Florida, United States

Site Status

St. Petersburg General Hospital

St. Petersburg, Florida, United States

Site Status

South Bay Hospital

Sun City Center, Florida, United States

Site Status

Capital Regional Medical Center

Tallahassee, Florida, United States

Site Status

HCA Florida South Tampa Hospital

Tampa, Florida, United States

Site Status

HCA Florida West Tampa Hospital

Tampa, Florida, United States

Site Status

Medical Center of Trinity

Trinity, Florida, United States

Site Status

JFK Medical Center - North Campus

West Palm Beach, Florida, United States

Site Status

Fairview Park Hospital

Dublin, Georgia, United States

Site Status

Eastern Idaho Regional Medical Center

Idaho Falls, Idaho, United States

Site Status

Menorah Medical Center

Overland Park, Kansas, United States

Site Status

Overland Park Regional Medical Center

Overland Park, Kansas, United States

Site Status

Wesley Woodlawn Hospital & ER

Wichita, Kansas, United States

Site Status

TriStar Greenview Regional Hospital

Bowling Green, Kentucky, United States

Site Status

Lakeview Regional Medical Center

Covington, Louisiana, United States

Site Status

Tulane Medical Center

New Orleans, Louisiana, United States

Site Status

Centerpoint Medical Center

Independence, Missouri, United States

Site Status

Research Medical Center

Kansas City, Missouri, United States

Site Status

Lee's Summit Medical Center

Lee's Summit, Missouri, United States

Site Status

Sunrise Hospital and Medical Center

Las Vegas, Nevada, United States

Site Status

Southern Hills Hospital & Medical Center

Las Vegas, Nevada, United States

Site Status

Trident Medical Center

Charleston, South Carolina, United States

Site Status

Grand Strand Medical Center

Myrtle Beach, South Carolina, United States

Site Status

Parkridge Medical Center

Chattanooga, Tennessee, United States

Site Status

Parkridge East Hospital

Chattanooga, Tennessee, United States

Site Status

TriStar Horizon Medical Center

Dickson, Tennessee, United States

Site Status

TriStar Hendersonville Medical Center

Hendersonville, Tennessee, United States

Site Status

TriStar Centennial Medical Center

Nashville, Tennessee, United States

Site Status

TriStar Southern Hills Medical Center

Nashville, Tennessee, United States

Site Status

TriStar StoneCrest Medical Center

Smyrna, Tennessee, United States

Site Status

Medical City Arlington

Arlington, Texas, United States

Site Status

St. David's Medical Center

Austin, Texas, United States

Site Status

St. David's North Austin Medical Center

Austin, Texas, United States

Site Status

Valley Regional Medical Center

Brownsville, Texas, United States

Site Status

HCA Houston Healthcare Conroe

Conroe, Texas, United States

Site Status

Corpus Christi Medical Center - Doctors Regional

Corpus Christi, Texas, United States

Site Status

Corpus Christi Medical Center - Bay Area

Corpus Christi, Texas, United States

Site Status

Corpus Christi Medical Center - Heart Hospital

Corpus Christi, Texas, United States

Site Status

Medical City Dallas

Dallas, Texas, United States

Site Status

Medical City Denton

Denton, Texas, United States

Site Status

Las Palmas Medical Center

El Paso, Texas, United States

Site Status

Del Sol Medical Center

El Paso, Texas, United States

Site Status

Medical City Fortworth

Fort Worth, Texas, United States

Site Status

Medical City Alliance

Fort Worth, Texas, United States

Site Status

Medical City Frisco

Frisco, Texas, United States

Site Status

HCA Houston Healthcare West

Houston, Texas, United States

Site Status

Medical City Las Colinas

Irving, Texas, United States

Site Status

HCA Houston Healthcare Kingwood

Kingwood, Texas, United States

Site Status

Medical City Lewisville

Lewisville, Texas, United States

Site Status

Methodist Hospital | Metropolitan

Live Oak, Texas, United States

Site Status

Methodist Hospital | Northeast

Live Oak, Texas, United States

Site Status

Rio Grande Regional Hospital Main Campus

McAllen, Texas, United States

Site Status

Medical City McKinney

McKinney, Texas, United States

Site Status

Medical City North Hills

North Richland Hills, Texas, United States

Site Status

HCA Houston Healthcare Southeast

Pasadena, Texas, United States

Site Status

HCA Houston Healthcare Pearland

Pearland, Texas, United States

Site Status

Medical City Plano

Plano, Texas, United States

Site Status

St. David's Round Rock Medical Center

Round Rock, Texas, United States

Site Status

Methodist Hospital | Texsan

San Antonio, Texas, United States

Site Status

Methodist Hospital | Specialty and Trasnplant

San Antonio, Texas, United States

Site Status

Methodist Hospital

San Antonio, Texas, United States

Site Status

HCA Houston Healthcare Mainland

Texas City, Texas, United States

Site Status

Medical City Weatherford

Weatherford, Texas, United States

Site Status

HCA Houston Healthcare Clear Lake

Webster, Texas, United States

Site Status

Ogden Regional Medical Center

Ogden, Utah, United States

Site Status

LewisGale Hospital Montgomery

Blacksburg, Virginia, United States

Site Status

John Randolph Medical Center

Hopewell, Virginia, United States

Site Status

LewisGale Hospital Pulaski

Pulaski, Virginia, United States

Site Status

Reston Hospital Center

Reston, Virginia, United States

Site Status

Henrico Doctor's Hospital

Richmond, Virginia, United States

Site Status

CJW Medical Center (Chippenham & Johnston Willis Campuses)

Richmond, Virginia, United States

Site Status

LewisGale Medical Center

Salem, Virginia, United States

Site Status

Countries

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United States

References

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Gohil SK, Septimus E, Kleinman K, Varma N, Sands KE, Avery TR, Mauricio A, Sljivo S, Rahm R, Roemer K, Cooper WS, McLean LE, Nickolay NG, Poland RE, Weinstein RA, Fakhry SM, Guy J, Moody J, Coady MH, Smith KN, Meador B, Froman A, Eibensteiner K, Hayden MK, Kubiak DW, Burks C, Burgess LH, Calderwood MS, Perlin JB, Platt R, Huang SS. Improving Empiric Antibiotic Selection for Patients Hospitalized With Skin and Soft Tissue Infection: The INSPIRE 3 Skin and Soft Tissue Randomized Clinical Trial. JAMA Intern Med. 2025 Jun 1;185(6):680-691. doi: 10.1001/jamainternmed.2025.0887.

Reference Type RESULT
PMID: 40208610 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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PH000763B_SST

Identifier Type: -

Identifier Source: org_study_id

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