{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:51:34Z","timestamp":1791273094882,"version":"4.1.0"},"reference-count":28,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X26105625_as1\">\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Some inpatient antibiotic use metrics have important limitations, including the absence of patient-level risk adjustment. To address this limitation, we previously developed two risk-standardized ratios (RSRs), one based on days of therapy (RSR-DOT) and the other on days of antibiotic spectrum coverage (RSR-DASC). Here, we evaluated the construct validity of these metrics by examining whether hospital performance was associated with the quality of antibiotic selection and duration in patients with either lower respiratory tract infections (LRIs) or urinary tract infections (UTIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105625_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Using Veterans Health Administration data from October 2020 through September 2021, we calculated RSR-DOT and RSR-DASC for 121 acute-care hospitals and selected 24 hospitals with relatively low or high values. At each hospital, a blinded infectious diseases physician reviewed 10 admissions each for LRI and UTI. Antibiotic selection at day 3 and total antibiotic duration were adjudicated and summarized as a 6-category ordinal composite outcome. Associations between RSR metrics and antibiotic-prescribing quality were evaluated using ordinal logistic regression; model-fit and bootstrap analyses compared RSR-DOT and RSR-DASC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105625_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We reviewed 479 admissions (239 LRI and 240 UTI). In LRI, lower RSR-DASC tended to be associated with a higher quality of antibiotic use (coefficient, 2.906 [\n                      <jats:italic>P<\/jats:italic>\n                      = .053]), whereas RSR-DOT was not (1.418 [\n                      <jats:italic>P<\/jats:italic>\n                      = .374]). In UTI, neither metric was associated with the quality of antibiotic therapy. Model-fit and bootstrap analyses consistently favor RSR-DASC over RSR-DOT for LRI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105625_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>RSR-DASC may capture antibiotic-prescribing quality more closely than RSR-DOT for LRI, but not for UTI, potentially supporting the value of spectrum-informed benchmarking metrics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2026.10562","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:02:35Z","timestamp":1791270155000},"page":"1-7","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Novel antibiotic stewardship metrics and the quality of antibiotic prescribing for lower respiratory and urinary tract infection across 24 VA hospitals"],"prefix":"10.1017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5706-613X","authenticated-orcid":false,"given":"Shungo","family":"Imai","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"UI Carver College of Medicine: The University of Iowa Roy J and Lucille A Carver"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8523-214X","authenticated-orcid":false,"given":"Daniel J.","family":"Livorsi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"UI Carver College of Medicine: The University of Iowa Roy J and Lucille A Carver"},{"name":"Iowa City VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Wright","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"UI Carver College of Medicine: The University of Iowa Roy J and Lucille A Carver"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Merchant","sequence":"additional","affiliation":[{"name":"Iowa City VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunkeun","family":"Cho","sequence":"additional","affiliation":[{"name":"University of California San Diego Moores Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4090-2274","authenticated-orcid":false,"given":"Bruce","family":"Alexander","sequence":"additional","affiliation":[{"name":"Iowa City VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michihiko","family":"Goto","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"UI Carver College of Medicine: The University of Iowa Roy J and Lucille A Carver"},{"name":"Iowa City VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"S0899823X26105625_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1372"},{"key":"S0899823X26105625_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt458"},{"key":"S0899823X26105625_ref1","doi-asserted-by":"crossref","first-page":"e702","DOI":"10.1093\/cid\/ciaa326","article-title":"National healthcare safety network standardized antimicrobial administration ratios (SAARs): a progress report and risk modeling update using 2017 data","volume":"71","author":"Edwards","year":"2020","journal-title":"Clin Infect 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Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X26105625","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:02:37Z","timestamp":1791270157000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X26105625\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":28,"alternative-id":["S0899823X26105625"],"URL":"https:\/\/doi.org\/10.1017\/ice.2026.10562","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"assertion":[{"value":"\u00a9 Veterans Health Administration, 2026","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}