Table 2.
Example of a prediction of antimicrobial de-escalation status by the spectrum score method
| A. Daily antimicrobial (Route of administration) use data | |||||
|---|---|---|---|---|---|
| Antimicrobial/Day | Hospital day 1 | Hospital day 2 | Hospital day 3 | Hospital day 4 | Hospital day 5 |
| Clindamycin (Clm) | Clm (PO) | Clm (PO) | |||
| Levofloxacin (Lev) | Lev (PO) | Lev (PO) | |||
| Cefepime (Cpm) | Cpm(IV) | Cpm(IV) | Cpm (IV) | Cpm (IV) | |
| Vancomycin (Vm) | Vm (IV) | Vm (IV) | Vm (IV) | Vm (IV) | |
| Daily Regimen Spectrum Score | 39.75 | 39.75 | 39.75 | 55.00 | 44.25 |
| B. Application of “smoothing” rules to daily antimicrobial use data | |||||
| Antimicrobial/Day | Hospital day 1 | Hospital day 2 | Hospital day 3 | Hospital day 4 | Hospital day 5 |
| Clindamycin (Clm) | Clm (PO) | Clm (PO) | |||
| Levofloxacin (Lev) | Lev (PO) | Lev (PO) | |||
| Cefepime (Cpm) | Cpm(IV) | Cpm (IV) | Cpm (IV) | ||
| Vancomycin (Vm) | Vm (IV) | Vm (IV) | Vm (IV) | ||
| Daily Regimen Spectrum Score | 39.75 | 39.75 | 39.75 | 44.25 | 44.25 |
| C. Calculation of spectrum score ∆ (Day 2 spectrum score – Day 4 spectrum score) | |||||
| [Cefepime + vancomycin score] | – | [Clindamycin + levofloxacin score] | = | Spectrum score ∆ | |
| 39.75 | – | 44.25 | = | -4.5 | |
| D. Adjustment of spectrum score ∆ for PO antimicrobials administered on day 4 | |||||
| Spectrum score ∆ | + | Administration credit | Final spectrum score ∆ after PO adjustment | ||
| -4.5 | + | 6 | 1.5 | ||
A. Example of antimicrobials administered on a daily basis during a 5 day hospitalization. Days 2 and 4 indicate baseline and de-escalation determination endpoints. Note that the daily antimicrobial regimen spectrum score increases on day 4 due to the addition of oral antimicrobials; however, IV antimicrobials are discontinued. B. Smoothing rules were applied to the daily antimicrobial administration data which results in a lower day 4 spectrum score. C. The spectrum score ∆ is negative suggesting that the spectrum of activity of is greater for the clindamycin + levofloxacin regimen than for the cefepime + vancomycin combination. D. The PO credit is applied to the case because 100% of the antimicrobials on day 4 were administered PO (6 points for regimens with ≥ 50 % of antimicrobials administered PO by day 4). The final spectrum score ∆ with PO credit is positive prediciting that a de-escalation event occurred.