Abstract
P-979. DASC-LOT Framework: A Novel Evaluation and Benchmarking Method to Assess Initiation, Duration, and Spectrum of Antibiotics Usage at Hospitals
Open forum infectious diseases, Vol.13(Supplement_1)
01/11/2026
DOI: 10.1093/ofid/ofaf695.1178
Abstract
Background Inpatient antibiotic stewardship programs (ASP) promote avoiding unnecessary initiation, excessively long duration, and overly broad-spectrum selection of antibiotics to optimize usage. Commonly used metrics, such as Days of Therapy (DOT) per Days Present (DP) or Standardized Antimicrobial Administration Ratio (SAAR), reflect the overall usage but do not incorporate spectrum, nor provide specific information for components (initiation, duration, and spectrum). We aimed to create a novel framework to reflect all three components while providing information specific to each, based on Days of Antimicrobial Spectrum Coverage (DASC). Methods We developed a mathematical framework to extract hospital-level variability with risk adjustment for three components (Figure 1), using DASC and length of therapy (LOT). This was applied to data from all 118 Veterans Health Administration (VHA) acute care hospitals, with models built on 2022–2023 data and validated with 2024 data. Patient demographics, intensive care status, specialty, 86 comorbidities, and 225 procedure categories were considered as candidate variables for risk-adjustments. Overall hospital performances were evaluated by composite metrics (predicted/expected [P/E] ratio), integrating three components (Figure 2), and three components in each hospital were visualized in a radar chart (Figure 3). Results The cohort included 727,958 unique patients with 9,363,922 days present (DP: 2022-2023: 6,257,368; 2024: 3,106,554). Hospital-level usage density ranged widely (DASC per 1,000 DP: 1,311-5,275 [interquartile range (IQR): 2,738-3,563]; LOT per 1,000 DP: 132.2-517.6 [IQR: 301.0-367.5]). Risk-adjustment models included 115 variables for initiation, 125 for duration, and 128 for spectrum components. P/E ratios ranged from 0.713 to 1.533 [IQR: 0.912-1.077] (Figure 2). Three-component evaluation could offer more specific information for each hospital about its usage pattern (Figure 4). Conclusion We propose a novel framework to assess ASP practices in initiation, duration, and spectrum separately while providing overall composite benchmarking. Further studies are needed to assess whether this framework reflects the appropriateness of antibiotic therapies or outcomes. Disclosures All Authors: No reported disclosures
Details
- Title: Subtitle
- P-979. DASC-LOT Framework: A Novel Evaluation and Benchmarking Method to Assess Initiation, Duration, and Spectrum of Antibiotics Usage at Hospitals
- Creators
- Michihiko Goto - University of IowaJames Merchant - University of Iowa, Internal MedicineHyunkeun Cho - University of IowaMatthew B Goetz - VA Greater Los Angeles Healthcare SystemDaniel J Livorsi - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Open forum infectious diseases, Vol.13(Supplement_1)
- DOI
- 10.1093/ofid/ofaf695.1178
- ISSN
- 2328-8957
- eISSN
- 2328-8957
- Publisher
- Oxford University Press
- Language
- English
- Date published
- 01/11/2026
- Academic Unit
- Infectious Diseases; Internal Medicine
- Record Identifier
- 9985121595902771
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