Application of DASC and AUSC metrics in evaluating antimicrobial stewardship interventions in critically ill patients
Abstract
ObjectiveConventional metrics reflect use volume, not spectrum breadth, limiting de-escalation assessment. Using days of antibiotic spectrum coverage (DASC) and antibiotic spectrum coverage use (AUSC), we applied a dual-dimensional framework stratified by restriction level to evaluate the impact of antimicrobial stewardship interventions on consumption and spectrum coverage in critically ill patients with infections.MethodsIn this single-centre retrospective before–after intensive care unit study, an antimicrobial stewardship program optimized prescribing and reduced broad-spectrum exposure. Antimicrobial use was stratified by restriction level and evaluated using conventional metrics, spectrum-based metrics and derived ratio metrics.ResultsA total of 200 patients were included, and baseline characteristics were comparable between the two groups. Among 200 patients (100 per period), median DDDs decreased from 26.25 to 17.90 (r = 0.223, 95% CI 0.087–0.351; P = 0.002), DOT from 24.00 to 14.00 days (r = 0.294, 95% CI 0.162–0.420; P < 0.001), and DASC from 219.50 to 135.00 (r = 0.290, 95% CI 0.156–0.413; P < 0.001). No statistically significant between-period differences were detected for AUD, AUSC, DASC/DOT, or AUSC/AUD. In the non-special-use stratum, DASC (114.50–63.50; r = 0.242, 95% CI 0.106–0.368; P < 0.001), AUD (99.87–87.24; r = 0.157, 95% CI 0.018–0.289; P = 0.027), and AUSC (923.93–761.25; r = 0.151, 95% CI 0.012–0.284; P = 0.033) were lower in the intervention period; no statistically significant differences were detected in the special-use stratum. AUD correlated with AUSC (Spearman ρ = 0.75), as did AUSC with DASC (ρ = 0.40; both P < 0.01). Length of stay was also shorter (median 15.00 vs. 11.00 days; P < 0.001) and cumulative use correlated with it (ρ = 0.74–0.79); after accounting for observation time, only the treatment-day rate remained significantly lower (adjusted IRR 0.834, 95% CI 0.736–0.944, P = 0.004).ConclusionIn this before-after study, cumulative DDDs, DOT, and DASC were lower during the intervention period, partly reflecting shorter length of stay. After adjustment, only the antibiotic treatment-day rate remained significantly lower, whereas DASC/DOT and AUSC/AUD were unchanged. DASC and AUSC may complement conventional metrics for describing spectrum exposure, but require further validation against prescribing appropriateness and clinical outcomes.
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BibTeX
@article{wang2026application,
title = {{Application of DASC and AUSC metrics in evaluating antimicrobial stewardship interventions in critically ill patients}},
author = {Sisi Wang and Yun Liu and Han Wang and Yuanyuan Yu and Can Luo and Jing Hu},
journal = {Frontiers in Pharmacology},
year = {2026},
month = nov,
doi = {10.3389/fphar.2026.1993215},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1993215},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Application of DASC and AUSC metrics in evaluating antimicrobial stewardship interventions in critically ill patients
AU - Sisi Wang
AU - Yun Liu
AU - Han Wang
AU - Yuanyuan Yu
AU - Can Luo
AU - Jing Hu
PY - 2026
DA - 2026/11/06
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1993215
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1993215
AB - ObjectiveConventional metrics reflect use volume, not spectrum breadth, limiting de-escalation assessment. Using days of antibiotic spectrum coverage (DASC) and antibiotic spectrum coverage use (AUSC), we applied a dual-dimensional framework stratified by restriction level to evaluate the impact of antimicrobial stewardship interventions on consumption and spectrum coverage in critically ill patients with infections.MethodsIn this single-centre retrospective before–after intensive care unit study, an antimicrobial stewardship program optimized prescribing and reduced broad-spectrum exposure. Antimicrobial use was stratified by restriction level and evaluated using conventional metrics, spectrum-based metrics and derived ratio metrics.ResultsA total of 200 patients were included, and baseline characteristics were comparable between the two groups. Among 200 patients (100 per period), median DDDs decreased from 26.25 to 17.90 (r = 0.223, 95% CI 0.087–0.351; P = 0.002), DOT from 24.00 to 14.00 days (r = 0.294, 95% CI 0.162–0.420; P < 0.001), and DASC from 219.50 to 135.00 (r = 0.290, 95% CI 0.156–0.413; P < 0.001). No statistically significant between-period differences were detected for AUD, AUSC, DASC/DOT, or AUSC/AUD. In the non-special-use stratum, DASC (114.50–63.50; r = 0.242, 95% CI 0.106–0.368; P < 0.001), AUD (99.87–87.24; r = 0.157, 95% CI 0.018–0.289; P = 0.027), and AUSC (923.93–761.25; r = 0.151, 95% CI 0.012–0.284; P = 0.033) were lower in the intervention period; no statistically significant differences were detected in the special-use stratum. AUD correlated with AUSC (Spearman ρ = 0.75), as did AUSC with DASC (ρ = 0.40; both P < 0.01). Length of stay was also shorter (median 15.00 vs. 11.00 days; P < 0.001) and cumulative use correlated with it (ρ = 0.74–0.79); after accounting for observation time, only the treatment-day rate remained significantly lower (adjusted IRR 0.834, 95% CI 0.736–0.944, P = 0.004).ConclusionIn this before-after study, cumulative DDDs, DOT, and DASC were lower during the intervention period, partly reflecting shorter length of stay. After adjustment, only the antibiotic treatment-day rate remained significantly lower, whereas DASC/DOT and AUSC/AUD were unchanged. DASC and AUSC may complement conventional metrics for describing spectrum exposure, but require further validation against prescribing appropriateness and clinical outcomes.
SN - 1663-9812
ER -