In this episode, I’ll discuss a novel metric for antibiotic stewardship.
Days of Therapy (DOT) is probably the most common metric to track antimicrobial stewardship efforts related to antibiotic consumption. DOT is not a perfect metric as it is calculated by calendar day regardless of the number of doses given, however, it is easily calculated which probably contributes to its popularity.
However this metric does not capture all stewardship activities and, if focused on exclusively, could lead to a mis-prioritization of antimicrobial stewardship efforts.
Two examples of where DOT fails to account for legitimate stewardship activities are:
1. The use of a combination regimen, even if it has lower side effects, is penalized when measuring by days of antibiotic therapy as each antibiotic is counted separately.
2. When narrowing therapy from a broad spectrum to narrow spectrum agent, the DOT metric is unaffected even though this is generally regarded as a positive stewardship activity.
To better account for these stewardship efforts, a group of physicians and pharmacists developed an alternative metric which they published in Clinical Infectious Disease. The metric is called Days of Antibiotic Spectrum Coverage (DASC).
To develop this metric the authors evaluated 77 different antibiotics and developed a scoring system based on spectrum of activity which ranges from 2 points to 15, depending on the antibiotic.
The authors then compared the new metric to DOT using a retrospective cohort study. There was little correlation between the 2 metrics. This supports the idea of using the new metric as it indicates that lower days of therapy do not necessarily correspond to higher use of narrow spectrum agents.
The metric is not perfect as it still doesn’t account for local resistance patterns and it is more complicated to determine than the simple DOT metric. However a simple one-time spreadsheet setup should be able to enable a hospital to calculate days of antibiotic spectrum coverage.
Hopefully, additional research will be performed using this new metric – first with post hoc analysis and then with prospective analysis – to determine if a reduction in Days of Antibiotic Spectrum Coverage can translate into other positive outcomes such as a reduction in resistance or C diff infection rates.
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