Description and validation of a spectrum score method to measure antimicrobial de-escalation in healthcare associated pneumonia from electronic medical records data

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.

ISSN: 1471-2334