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.