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. 2022 Sep 10;75(4):567-576.
doi: 10.1093/cid/ciab1034.

Days of Antibiotic Spectrum Coverage: A Novel Metric for Inpatient Antibiotic Consumption

Satoshi Kakiuchi  1   2 , Daniel J Livorsi  1   2 , Eli N Perencevich  1   2 , Daniel J Diekema  1 , Dilek Ince  1 , Kunatum Prasidthrathsint  1 , Patrick Kinn  3 , Kelly Percival  3 , Brett H Heintz  4 , Michihiko Goto  1   2
Affiliations

Days of Antibiotic Spectrum Coverage: A Novel Metric for Inpatient Antibiotic Consumption

Satoshi Kakiuchi et al. Clin Infect Dis. .

Abstract

Background: Days of therapy (DOT), the most widely used benchmarking metric for antibiotic consumption, may not fully measure stewardship efforts to promote use of narrow-spectrum agents and may inadvertently discourage the use of combination regimens when single-agent alternatives have greater adverse effects. To overcome the limitations of DOT, we developed a novel metric, days of antibiotic spectrum coverage (DASC), and compared hospital performances using this novel metric with DOT.

Methods: We evaluated 77 antibiotics in 16 categories of antibacterial activity to develop our spectrum scoring system. DASC was then calculated as cumulative daily antibiotic spectrum coverage (ASC) scores. To compare hospital benchmarking using DOT and DASC, we conducted a retrospective cohort study of adult patients admitted to acute care units within the Veterans Health Administration system in 2018. Antibiotic administration data were aggregated to calculate each hospital's DOT and DASC per 1000 days present (DP) for ranking.

Results: The ASC score for each antibiotic ranged from 2 to 15. There was little correlation between DOT per 1000 DP and DASC per DOT, indicating that lower antibiotic consumption at a hospital does not necessarily mean more frequent use of narrow-spectrum antibiotics. The differences in each hospital's ranking between DOT and DASC per 1000 DP ranged from -29.0% to 25.0%, respectively, with 27 hospitals (21.8%) having differences >10%.

Conclusions: We propose a novel composite metric for antibiotic stewardship, DASC, that combines consumption and spectrum as a potential replacement for DOT. Further studies are needed to evaluate whether benchmarking using the DASC will improve evaluations of stewardship.

Keywords: antibiotic consumption metric; antibiotic spectrum; antibiotic stewardship; hospital benchmarking.

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Conflict of interest statement

Potential conflicts of interest. E. N. P. reports support from the US Department of Veterans Affairs (grants QUE 15-269 and RVR 19-477), outside the conduct of the study. D. J. D. reports grants to their institution from bioMerieux, to support clinical trials, and individual payments from OpGen, for consulting on novel diagnostics, and JMI Laboratories, for consulting on antibiotic resistance surveillance studies. D. I. reports payments to their institution from Gilead Sciences, for clinical trials on remdesivir, and from Leidos, for Adaptive COVID-19 Treatment Trial 3 and Adaptive COVID-19 Treatment Trial 4, clinical trials sponsored by the National Institutes of Health; D. I. also serves on the data and safety monitoring board for Evergreen Pharma. P. K. reports grants from Accelerate Diagnostics to University of Iowa Hospitals & Clinics principal investigators to support clinical study, outside the submitted work, and reports serving on an advisory panel for Gilead Sciences, on remdesivir in coronavirus disease 2019. M. G. reports support for the present study from the VHA Patient Safety Center for Inquiry program. D. J. L. reports support from the Health Services Research and Development Service (grant 20-240 [coinvestigator], career development award 16-204, and grant D 20-280 [principal investigator: D. J. L.]), the Centers for Diseases Control and Prevention EpiCenter (grant J207400-G; coinvestigator), and the Merck Investigator Studies Program. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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