Background: Measurement of antimicrobial use (AU) is a critical component of designing and monitoring antimicrobial stewardship activities. The CDC, IDSA, and other organizations have identified antimicrobial days of therapy per 1000 patient days (DOT/1000d) based on medication administration data as the preferred AU metric. Although third-party software can compile AU data using this metric, considerable limitations may exist. We report our experience with an internally-developed AU benchmarking report at a large integrated healthcare system.
Methods: This benchmarking tool was piloted at Cleveland Clinic Health System (CCHS) using data from 9 inpatient acute care facilities. The numerator of the DOT/1000d metric was achieved by starting with a medication administration report and combining the patients account number with the date, route, and generic name of each unique antimicrobial administered. We then totaled the number of unique values to obtain DOT for each medication/route combination. Data were extracted from a separate admissions database to calculate the denominator of the metric. In alignment with the CDC AU Module, 89 antimicrobials were included in the report for Q4 2015 and Q1 2016. AU data were compared internally and against a literature-based reference of 839 DOT/1000d.
Results: During Q4 2015, mean AU across CCHS was 704 (± 187) DOT/1000d; range 368-962. During Q1 2016, mean CCHS AU was 912 (±243) DOT/1000d; range 501-1243. Antimicrobials with significant variability in mean DOT/1000d across the health system during Q1 2016 included: ceftriaxone 68 (±38); cefepime 14 (±11); aztreonam 8 (±5); daptomycin 6 (±4); linezolid 4 (±3); tigecycline 4 (±7); micafungin 6 (±5); and voriconazole 3 (±5). Broad-spectrum antimicrobial use, including antifungals, was expectedly higher at transplant and oncology centers.
Conclusion: As anticipated, interseasonal and interfacility variation in AU was reflected in our health system DOT/1000d report. An AU benchmarking strategy supports meaningful comparison of AU across locations and over time. This tool highlights important differences within a health system, while also providing actionable data needed to direct stewardship initiatives at the system- , hospital-, and care unit-level.
A. Pallotta, None
J. Chalmers, None
E. Vogan, None
X. Jiang, None
T. G. Fraser, None
S. Gordon, None
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