Days of Antibiotic Spectrum Coverage Trends and Assessment in Patients with Bloodstream Infections: A Japanese University Hospital Pilot Study

Abstract

The antibiotic spectrum is not reflected in conventional antimicrobial metrics. Days of antibiotic spectrum coverage (DASC) is a novel quantitative metric for antimicrobial consumption developed with consideration of the antibiotic spectrum. However, there were no data regarding disease and pathogen-specific DASC. Thus, this study aimed to evaluate the DASC trend in patients with bloodstream infections (BSIs). DASC and days of therapy (DOT) of in-patients with positive blood culture results during a 2-year interval were evaluated. Data were aggregated to calculate the DASC, DOT, and DASC/DOT per patient stratified by pathogens. During the 2-year study period, 1443 positive blood culture cases were identified, including 265 suspected cases of contamination. The overall DASC, DASC/patient, DOT, DOT/patient, and DASC/DOT metrics were 226,626; 157.1; 28,778; 19.9; and 7.9, respectively. A strong correlation was observed between DASC and DOT, as well as DASC/patient and DOT/patient. Conversely, DASC/DOT had no correlation with other metrics. The combination of DASC and DOT would be a useful benchmark for the overuse and misuse evaluation of antimicrobial therapy in BSIs. Notably, DASC/DOT would be a robust metric to evaluate the antibiotic spectrum that was selected for patients with BSIs.

Evaluation of antimicrobial stewardship activities using antibiotic spectrum coverage

“…On the other hand, DASC/DOT did not correlate with DOT. This study also suggests that the DASC/DOT can be employed as an independent indicator for evaluating the spectrum of antimicrobial agents used, as evidenced by previous studies 11 . However, a weak correlation was observed between AUSC/AUD and AUD, suggesting that AUSC/AUD was influenced by variations in DDD.…”

“…Recently, the days of antibiotic spectrum coverage (DASC), which uses the antibiotic spectrum coverage (ASC) score, has been proposed as a new tool for evaluating antimicrobial use 10 , 11 . The DASC is calculated from the DOT and ASC scores, which combine consumption and spectrum.…”