Data analysis
For the purposes of antibiotic stewardship, we calculated days of
therapy (DOT) and length of therapy (LOT).18,19 One
DOT represents the administration of a single antibiotic on a given
calendar day, even if multiple doses are given on that day. LOT is the
number of days a patient is receiving antibiotics regardless of the
number of different agents administered. We compared administration of ≥
4 antibiotics simultaneously, use of antibiotics with overlapping
antimicrobial activity for ≥2 days, de-escalation/discontinuation with
negative cultures by day 6, start of antibiotics without obtaining
cultures, antibiotic initiation without a clear source or fever and with
ANC>500/μl, use of standard versus other non-standard
regimens for empirical therapy (defined as cephalosporins without
anti-Pseudomonas activity such as ceftriaxone and cefotaxime,
ceftazidime monotherapy, colistin, metronidazole, and others), early use
of antifungals before day 4 of fever, number of patients admitted for
sepsis to ICU, and number of deaths before and after PHIG intervention.
In all participating units, a feedback report was sent every six months
throughout the study period to inform them about their specific progress
with respect to implementation of the CPG.