| DOI: DOI:10.29090/psa.2024.03.24.AP0730 | Pharm Sci Asia 2024; 51(4), 301-313 |
Measurement of DDD and DOT metrics for optimizing antimicrobial surveillance in two tertiary hospitals in Viet Nam: A four-year retrospective studyNhien Phan-thuy Nguyen1, Quynh Thuy Truong2, Thao Phuong Huynh2, Hien Thi-thu Pham3, Thanh Dinh Le4, Yen Thi-hai Nguyen1, Nga Thi-quynh Nguyen1,*
1 Department of Pharmaceutical Administration, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
2
Department of Pharmacy, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
3
Department of Pharmacy, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
4
Board of Directors, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
Monitoring antimicrobial consumption is essential for evaluating antibiotic stewardship programs and controlling resistance. In Vietnam, Defined Daily Dose (DDD) is prioritized over Day of Therapy (DOT) for antimicrobial surveillance due to resource constraints and hospital data retrieval challenges. However, compared to DOT, DDD has been criticized due to its unrepresentativeness when relying on pre-defined values and undefined in pediatric patients. This study aimed to compare DDD and DOT metrics of antimicrobials for determining the optimal metric for resource allocation. We retrospectively analyzed clinical and administrative data of inpatients receiving antimicrobials at two tertiary hospitals from 01/2017 to 12/2020. Our primary outcome was the differences between antimicrobial use measured by DDDs per 1000 patient-days (DDD/1000PDs) and DOTs per 1000 patient-days (DOT/1000PDs) across periods and age-specific groups. We assessed the relationship between DDD- and DOT-based metrics over time using linear regression. Cohen’s d was used to evaluate the standardized mean differences between DDDs and DOTs among pediatric and adult inpatients. Two hospitals recorded 1011.68 and 1036.76 DDD/1000PDs, exceeding DOT estimates (920.87 and 838.44 DOT/1000PDs, respectively). DDD- and DOT- metrics showed significant linear relationships for most antimicrobials, except for cefuroxime, ceftriaxone, and linezolid. DDD/1000PDs of fluoroquinolone use surpassed DOT/1000PDs (p <0.001), indicating the administered daily doses often greater than the DDD value assigned by the World Health Organization (WHO-DDD). Carbapenem use showed comparable results between DOT and DDD because the daily dose aligned with WHO-DDD and these antibiotics were mainly used in adult inpatients. Pediatric and adult inpatients displayed DDD and DOT differences, particularly in glycopeptides, with a small effect size of d=0.18 in children and a large one of d=0.96 in adults. We suggest using DDD to measure the consumption of last-resort antibiotics efficiently. Additionally, DOT should be prioritized to prevent overestimating consumption levels in frequently used antimicrobial groups like fluoroquinolones
Keyword:
Antimicrobial consumption; Defined Daily Dose; Day of Therapy; DDD; DOT; Vietnam
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