Spectrum scores: Toward a better definition of de-escalation

Ilges, Dan; Ritchie, David J.; Krekel, Tamara; Neuner, Elizabeth; Micek, Scott T.

doi:10.1017/ice.2022.207

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Data were aggregated for each month of the study periods. The antibiotic spectrum index (ASI) was calculated using an expanded and modified version developed by Gerber et al 10,11 Assessment of intravenous versus oral antibiotic usage was performed using the digestive DOT (dDOT) over total DOT (tDOT) metric as described by Moehring et al 12 Descriptive data on types of recommendations and acceptance rate were evaluated. Patient outcomes included length of stay and in-hospital mortality.…”

Section: Methodsmentioning

confidence: 99%

Mixed methods evaluation of handshake antimicrobial stewardship on adult inpatient medicine floors

Neuner,

Atkinson,

Ilges

et al. 2023

ASHE

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Objective: To evaluate the effects of handshake antimicrobial stewardship on medicine floors at a large tertiary care hospital. Design: Retrospective observational study. Setting: 1,278-bed academic hospital. Patients: Adults admitted to non-ICU medicine services. Interventions: A handshake stewardship team consisting of an infectious diseases (ID) physician and pharmacist reviewed charts of patients receiving antimicrobials on medicine floors without a formal ID consult. Recommendations were communicated in-person to providers and acceptance rates were examined with descriptive statistics. Additional data regarding program perception among providers were obtained via surveys. Antibiotic usage trends were extracted from National Healthcare Safety Network Antimicrobial Use option data and evaluated using an interrupted time-series analysis pre- and post-intervention. Results: The overall acceptance rate of interventions was 80%, the majority being recommendations either to discontinue (37%) or de-escalate therapy (28%). Medical residents and hospitalists rated the intervention favorably with 90% reporting recommendations were helpful all or most of the time. There was a statistically significant decrease in vancomycin (78 vs 70 DOT/1,000 d present (DP), p = 0.002) and meropenem (24 vs 17 DOT/1,000 DP, p = 0.007) usage and a statistically significant increase in amoxicillin-clavulanate usage (11 vs 15 DOT/1,000 DP, p < 0.001). Overall antibiotic usage remained unchanged by the intervention, though pre-intervention there was a nonsignificant overall increasing trend while post-intervention there was a nonsignificant decreasing trend in overall usage. There was no change in in-hospital mortality. Conclusion: The addition of handshake stewardship with adult medicine services was favorably viewed by participants and led to shifts in antibiotic usage.

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Section: Methodsmentioning

confidence: 99%

Mixed methods evaluation of handshake antimicrobial stewardship on adult inpatient medicine floors

Neuner,

Atkinson,

Ilges

et al. 2023

ASHE

Self Cite

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A Broad Spectrum of Possibilities: Spectrum Scores as a Unifying Metric of Antibiotic Utilization

Ilges

Tande

Stevens

2023

Clinical Infectious Diseases

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Days of therapy (DOT) currently serve as the standard antimicrobial utilization metric; however, by assigning the same weight to each agent rather than accounting for differences in spectrum of activity, DOT ignore key differences between agents that are fundamental to infectious diseases and critical to antimicrobial stewardship. Spectrum scoring assigns numeric values to individual antibiotic agents to quantify their spectrum of activity, allowing for normalization of antibiotic utilization data. When used in conjunction with traditional metrics, spectrum scores may offer further clarity to the picture of antibiotic utilization; however, issues related to development, application, and standardization of spectrum scores remain. Despite these challenges, the potential applications of spectrum scores are vast. Herein, we summarize existing data and explore the future of spectrum scoring, including application to both data analysis and routine patient care, use in inpatient and outpatient settings, integration within the electronic medical record, and opportunities for future research.

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Spectrum scores: Toward a better definition of de-escalation

Cited by 2 publications

References 10 publications

Mixed methods evaluation of handshake antimicrobial stewardship on adult inpatient medicine floors

Mixed methods evaluation of handshake antimicrobial stewardship on adult inpatient medicine floors

A Broad Spectrum of Possibilities: Spectrum Scores as a Unifying Metric of Antibiotic Utilization

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