ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2026
DASC-LOT Framework and S3 Metric: A Novel Evaluation and Benchmarking Method to Assess Initiation, Duration, and Spectrum of Antimicrobial Usage at Inpatient Hospital Settings.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundInpatient antimicrobial stewardship programs (ASPs) promote avoiding unnecessary initiation, excessively long duration, and overly broad-spectrum selection of antimicrobials, but currently available metrics do not adequately reflect or distinguish these 3 components. We aimed to develop a novel framework that captures them while providing information specific to each, based on days of antimicrobial spectrum coverage (DASC) and length of therapy (LOT).
methodsWe developed a 3-level conditional modeling framework to extract hospital-level variability, risk-adjusted for 3 components (initiation, duration, and spectrum). This was applied to data from 118 Veterans Health Administration (VHA) hospitals, with models built on 2022-2023 data and validated with 2024 data. Patient demographics, intensive care status, admitting specialty, 86 comorbidities, and 224 procedure categories were considered candidate variables for risk adjustment. Overall hospital performance was evaluated using a composite metric that integrated 3 components ("S3 [start, stop, select] Metric") and was visualized in a radar chart for each hospital.
resultsThe cohort included 727 958 unique patients with 9 363 922 days present. Hospital-level usage ranged widely (DASC per 1000 DP: 1311-5275 [interquartile range (IQR): 2738-3563]; LOT per 1000 DP: 132.2-517.6 [IQR: 301.0-367.5]). Risk-adjustment models included 116 variables for initiation, 77 for duration, and 91 for spectrum components. S3 metrics ranged from 0.703 to 1.572 (IQR: 0.906-1.086). A 3-component evaluation could provide specific information on each hospital's usage patterns.
conclusionsWe propose a DASC-LOT framework and S3 metric to assess ASP practices in initiation, duration, and spectrum separately while providing overall composite benchmarking.
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