Antibiotic spectrum coverage scoring as a potential metric for evaluating the antimicrobial stewardship team activity: a single-center study

Kazutaka Oda; Hideyuki Hayashi; Keiichi Yamamoto; Shoji Kondo; Tomomi Katanoda; Shinichiro Okamoto; Toshikazu Miyakawa; Eisaku Iwanaga; Kisato Nosaka; Tatsuya Kawaguchi; Hirotomo Nakata

doi:10.1017/ice.2024.137

Antibiotic spectrum coverage scoring as a potential metric for evaluating the antimicrobial stewardship team activity: a single-center study

Infect Control Hosp Epidemiol. 2024 Oct 10;45(11):1-9. doi: 10.1017/ice.2024.137. Online ahead of print.

Authors

Kazutaka Oda^{1

2}, Hideyuki Hayashi^{2

3}, Keiichi Yamamoto^{2

3}, Shoji Kondo^{1

2}, Tomomi Katanoda^{1

2}, Shinichiro Okamoto^{2

4}, Toshikazu Miyakawa^{2

5}, Eisaku Iwanaga^{2

6}, Kisato Nosaka^{2

6}, Tatsuya Kawaguchi^{2

7}, Hirotomo Nakata^{2

6}

Affiliations

¹ Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan.
² Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan.
³ Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
⁴ Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
⁵ Department of Hematology, Kumamoto Shinto General Hospital, Kumamoto, Japan.
⁶ Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto University Hospital, Kumamoto, Japan.
⁷ Department of Medical Technology, Kumamoto Health Science University, Kumamoto, Japan.

Abstract

Objective: Days of antibiotic spectrum coverage (days of ASC: DASC) is a metric for antibiotic usage calculated by ASC scores for spectrum and addresses limitations of days of therapy (DOT), which does not include spectrum. This study aims to investigate whether ASC-related metrics offer different aspects compared to aggregated DOT for all antibiotics (DOT_total) and to assess their correlation in evaluating the impact of antimicrobial stewardship team (AST) programs.

Design: Retrospective.

Setting: A single center within an 845-bed hospital.

Methods: Trends in DOT_total, DASC, and the DASC/DOT ratio, representing the average spectrum coverage per therapy day, were analyzed pre- and post-AST programs (April 2018) from January 2015 to December 2023, using interrupted time series analysis. Independent of the DASC/DOT, we also advocated ASC-stratified DOT (ASDOT), which facilitates comprehensive evaluation of DOT across ASC scores of <6, 6-10, and >10, representing narrow-, intermediate-, and broad-spectrum antibiotics.

Results: Among inpatients, AST programs significantly moderated the increasing trends of these metrics. Specifically, although the rates of increase in DOT_total and DASC were slowed or plateaued, the DASC/DOT ratio decreased (P < 0.001). ASDOT metrics revealed a decrease and subsequent plateau in DOT_total for the broad- and intermediate-spectrum antibiotics, with an increase observed for the narrow-spectrum antibiotics (P < 0.001 for each). DASC did not provide additional insights in the outpatient's population.

Conclusions: The study demonstrates that ASC-related metrics may yield different and useful conclusions about the effectiveness of AST programs for inpatients.