Hospital antibiotic stewardship indicators using days of therapy (DOT) and DOT per 1,000 patient-days in Southeast Iran

Abstract

Introduction: Days of therapy (DOT) and DOT per 1,000 patient-days are key indicators of hospital antibiotic use and are critical for antimicrobial stewardship. Given the frequent unsupervised use of antibiotics and limited data on these metrics, this study provides insights into hospital antibiotic consumption.

Methodology: A prospective descriptive study was conducted from 23 October to 21 November 2024, at Amir Al-Mo'menin Hospital, Zabol, which is a teaching hospital with multiple clinical wards. All patients receiving at least 1 dose antibiotic were included. Data on demographics, hospital stay, and antibiotic prescriptions were extracted from the hospital information system. DOT and DOT per 1,000 patient-days were calculated for all antibiotics. Statistical analyses were performed using SPSS v25, with quantitative variables reported as mean ± SD and qualitative variables as frequencies and percentages.

Results: Of 3,518 patients, 2,373 (66.2%) received antibiotics. Antibiotics use was highest in the infectious diseases and respiratory wards (100%) and lowest in obstetrics and gynecology (41.2%). Ceftriaxone was the most used antibiotic (DOT 3,118; DOT/1,000 patient-days 256.94); imipenem was the least used (DOT 71; DOT/1000 patient-days 5.85). Duration of antibiotic treatment was highest in the intensive care unit (ICU), neonatal ICU (NICU) and burn wards. Pediatric wards had the highest antibiotic consumption (DOT 3,195; DOT/1000 patient-days 263.3).

Conclusions: Antibiotic use in this hospital was higher than in developed countries, driven by empiric therapy, delayed culture results, and lack of guidelines. Addressing these factors by timely culture diagnostics and local guideline development could optimize use and reduce unnecessary antibiotic administration.