Comparison of Spectrum Coverage Score-based Antimicrobial Consumption in Acute Care Hospitals Over Eight Years: A Multicentric Study

Background. Progress in antimicrobial stewardship programs has introduced new means of assessing antimicrobial use. Days of antibiotic spectrum coverage (DASC) incorporate spectrum data into traditional metrics, such as days of therapy (DOT). This study evaluated DASC across 12 hospitals to assess antimicrobial consumption and the streamlining process. Methods. Data on antimicrobial consumption were collected from 12 hospitals in three regions from April 2016 to March 2024. Trends in streamlining (DASC/DOT) were assessed using linear regression. Spearman's rank-order correlation was used to test for any correlation between DASC/DOT and DOT per 1000 patient-days (PD). Hospital features, including intensive care unit (ICU) capacity and transplant services, were also assessed. Results. In total, data from 96 months revealed median DOT 303.4, DASC 2107.0, and DASC/DOT 7.2. No significant correlation was found between DASC/DOT and DOT per 1000 PD (rho: 0.11; P = .73). University hospitals and a cancer center had higher DASC/DOT (median: 7.7 and 8.0, respectively) than community hospitals (median: 6.9) most likely because they provided better access to the ICU and transplantation services. The decline in DASC/DOT seen in the university hospitals after carbapenem use was restricted to August 2022. The median DASC/DOT in eastern and western Japan was 6.9 and 7.2, respectively, suggesting that the antimicrobial streamlining process had made more progress in the hospitals in Tokyo than in those in Okinawa. Conclusions. DASC/DOT is a valuable tool for evaluating antimicrobial use and streamlining. Regional and institutional comparisons can help identify facilities requiring more effort to promote antimicrobial stewardship.