Excess antibiotic days may be attributed to inappropriate empiric therapy or excessive treatment durations. Accessible data and analysis methods are needed to both develop an optimal stewardship strategy and then measure the impact of that work.
Most stewardship programs use days of therapy (DOT) per 1,000 days present to measure antibiotic use. DOT is the number of calendar days a patient receives an antibiotic, with each agent counted individually. The denominator, 1,000 days present, allows stewards to compare use among hospitals or units with different patient volumes. Although helpful for benchmarking to recognize higher than expected rates, this metric does not delineate between excessive new starts versus durations of therapy, which require different stewardship strategies. For example, longer durations could be addressed with prospective audit and feedback, while empiric choice or new starts could be affected by the ordering process or restriction criteria. To more quickly target and develop our stewardship strategies within the Duke Antimicrobial Stewardship Outreach Network (DASON), a metric called targeted antimicrobial use admission (TAUA) was developed.