A systematic scoping review of metrics utilized to measure antibiotic consumption in hospital settings
Antimicrobial stewardship (AMS) programs were introduced to promote the judicious use of antimicrobials and to combat antimicrobial resistance. Quantifying antibiotic consumption is an important part of AMS initiatives to achieve these objectives. However, various metrics are available for measuring...
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| Vydáno v: | British journal of clinical pharmacology |
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| Médium: | Journal Article |
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England
28.05.2025
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| ISSN: | 0306-5251, 1365-2125, 1365-2125 |
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| Abstract | Antimicrobial stewardship (AMS) programs were introduced to promote the judicious use of antimicrobials and to combat antimicrobial resistance. Quantifying antibiotic consumption is an important part of AMS initiatives to achieve these objectives. However, various metrics are available for measuring antibiotic usage, each providing valuable insights but also possessing inherent limitations. The aim of this scoping review was to compare AMS metrics quantifying antibiotic consumption that have been evaluated within hospital settings. It examines the advantages, disadvantages, complexity and components of these metrics to inform their implementation. Four electronic databases, Medline, Embase, Web of Science and the Cochrane Library, were searched to identify articles, where two or more antibiotic consumption metrics were compared in the hospital setting. A total of 4874 articles were screened, with 21 selected for inclusion. The two most commonly used metrics ( n = 19/21 studies) were defined daily dose (DDD) and days of therapy (DOT), which were compared to other metrics. DDD most likely overestimates antibiotic consumption for certain antibiotics such as beta‐lactams and in certain settings such as the intensive care unit. Days of antibiotic spectrum coverage (DASC) and antibiotic spectrum index (ASI) are newer metrics that incorporate antibiotic spectrum and have been compared to DOT. DASC and ASI have shown low correlation with DOT. Reliance on a single metric such as DDD or DOT does not provide an accurate picture of antibiotic use. Hospitals should use DDD or DOT in combination with DASC or ASI to measure antibiotic consumption and the effectiveness of AMS programs. |
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| AbstractList | Antimicrobial stewardship (AMS) programs were introduced to promote the judicious use of antimicrobials and to combat antimicrobial resistance. Quantifying antibiotic consumption is an important part of AMS initiatives to achieve these objectives. However, various metrics are available for measuring antibiotic usage, each providing valuable insights but also possessing inherent limitations. The aim of this scoping review was to compare AMS metrics quantifying antibiotic consumption that have been evaluated within hospital settings. It examines the advantages, disadvantages, complexity and components of these metrics to inform their implementation. Four electronic databases, Medline, Embase, Web of Science and the Cochrane Library, were searched to identify articles, where two or more antibiotic consumption metrics were compared in the hospital setting. A total of 4874 articles were screened, with 21 selected for inclusion. The two most commonly used metrics (n = 19/21 studies) were defined daily dose (DDD) and days of therapy (DOT), which were compared to other metrics. DDD most likely overestimates antibiotic consumption for certain antibiotics such as beta-lactams and in certain settings such as the intensive care unit. Days of antibiotic spectrum coverage (DASC) and antibiotic spectrum index (ASI) are newer metrics that incorporate antibiotic spectrum and have been compared to DOT. DASC and ASI have shown low correlation with DOT. Reliance on a single metric such as DDD or DOT does not provide an accurate picture of antibiotic use. Hospitals should use DDD or DOT in combination with DASC or ASI to measure antibiotic consumption and the effectiveness of AMS programs.Antimicrobial stewardship (AMS) programs were introduced to promote the judicious use of antimicrobials and to combat antimicrobial resistance. Quantifying antibiotic consumption is an important part of AMS initiatives to achieve these objectives. However, various metrics are available for measuring antibiotic usage, each providing valuable insights but also possessing inherent limitations. The aim of this scoping review was to compare AMS metrics quantifying antibiotic consumption that have been evaluated within hospital settings. It examines the advantages, disadvantages, complexity and components of these metrics to inform their implementation. Four electronic databases, Medline, Embase, Web of Science and the Cochrane Library, were searched to identify articles, where two or more antibiotic consumption metrics were compared in the hospital setting. A total of 4874 articles were screened, with 21 selected for inclusion. The two most commonly used metrics (n = 19/21 studies) were defined daily dose (DDD) and days of therapy (DOT), which were compared to other metrics. DDD most likely overestimates antibiotic consumption for certain antibiotics such as beta-lactams and in certain settings such as the intensive care unit. Days of antibiotic spectrum coverage (DASC) and antibiotic spectrum index (ASI) are newer metrics that incorporate antibiotic spectrum and have been compared to DOT. DASC and ASI have shown low correlation with DOT. Reliance on a single metric such as DDD or DOT does not provide an accurate picture of antibiotic use. Hospitals should use DDD or DOT in combination with DASC or ASI to measure antibiotic consumption and the effectiveness of AMS programs. Antimicrobial stewardship (AMS) programs were introduced to promote the judicious use of antimicrobials and to combat antimicrobial resistance. Quantifying antibiotic consumption is an important part of AMS initiatives to achieve these objectives. However, various metrics are available for measuring antibiotic usage, each providing valuable insights but also possessing inherent limitations. The aim of this scoping review was to compare AMS metrics quantifying antibiotic consumption that have been evaluated within hospital settings. It examines the advantages, disadvantages, complexity and components of these metrics to inform their implementation. Four electronic databases, Medline, Embase, Web of Science and the Cochrane Library, were searched to identify articles, where two or more antibiotic consumption metrics were compared in the hospital setting. A total of 4874 articles were screened, with 21 selected for inclusion. The two most commonly used metrics ( n = 19/21 studies) were defined daily dose (DDD) and days of therapy (DOT), which were compared to other metrics. DDD most likely overestimates antibiotic consumption for certain antibiotics such as beta‐lactams and in certain settings such as the intensive care unit. Days of antibiotic spectrum coverage (DASC) and antibiotic spectrum index (ASI) are newer metrics that incorporate antibiotic spectrum and have been compared to DOT. DASC and ASI have shown low correlation with DOT. Reliance on a single metric such as DDD or DOT does not provide an accurate picture of antibiotic use. Hospitals should use DDD or DOT in combination with DASC or ASI to measure antibiotic consumption and the effectiveness of AMS programs. |
| Author | Kandimahforoujaki, Marjan Patanwala, Kiplin A. Patanwala, Asad E. Alffenaar, Jan‐Willem C. |
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| Cites_doi | 10.1007/BF01584358 10.2807/1560‐7917.ES.2024.29.37.2300734 10.1016/S2666‐5247(24)00134‐4 10.1093/jac/dks021 10.1097/MCC.0000000000000967 10.7326/M18‐0850 10.18549/PharmPract.2019.3.1482 10.1016/j.ijantimicag.2023.106710 10.1093/jac/dkx244 10.1093/jac/dky118 10.1186/s13756‐019‐0471‐0 10.1016/j.cmi.2019.08.007 10.1093/cid/ciab1034 10.3390/antibiotics8010007 10.1038/s41598‐024‐64944‐2 10.1086/665324 10.1093/jac/dkt268 10.1111/j.1469‐0691.2009.02920.x 10.1017/ice.2017.94 10.1016/S0140‐6736(24)00876‐6 10.1016/j.jiac.2018.08.001 10.1093/jac/dkq378 10.1093/jac/dkp399 10.1017/ice.2021.467 10.1016/j.jhin.2019.03.002 10.1017/ice.2022.312 10.1586/eri.12.18 10.1016/j.jiac.2023.10.012 10.1016/j.jcf.2024.03.004 10.3389/fphar.2022.913568 10.1016/j.semperi.2020.151329 10.1093/cid/ciw118 10.1093/cid/cir672 10.1093/jac/dkt458 10.1017/ice.2023.197 10.2807/1560‐7917.ES.2024.29.46.2400317 10.1097/INF.0000000000003446 |
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