979. Implementation of an Antibiotic Stewardship Program to Increase Appropriate Antibiotic Use in the Hospital on Aruba 
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDweek Aruba poster 2016 number 979.pdf (177.8 kB)
  • Background: Aruba is a constituent country of the Netherlands, and since antimicrobial resistance is a major concern at the island, Antibiotic Stewardship Program (ASP) strategies should be started. In the Netherlands the implementation of an antibiotic (AB) checklist resulted in more appropriate antibiotic use. The aim of this project was to start ASP on Aruba by introduction of the checklist, and to test the effectiveness of the checklist in a different setting (fig 1).

    Methods: The pilot program consisted of three periods of two months, namely: 1) collection of baseline data concerning the current antibiotic use; 2) start of ASP activities, including a kick-off symposium, clinical lessons, and the implementation of the AB-checklist; 3) continuation of activities and collection of intervention data.

    The baseline and intervention data were compared with logistic regression analyses while accounting for potential confounders. The primary endpoint was appropriate antibiotic use measured by validated quality indicators (QI), which were mentioned on the checklist.

    Results: In a comparison of 150 baseline with 173 intervention patients, the QI sum score increased significantly, but the score did not increase for each separate QI (table 1). The checklist was completed for 60% of all eligible patients.

    Conclusion: The awareness created by the ASP activities including the implementation of the AB-checklist resulted in an increase in sum score of QIs for appropriate antibiotic use. More initiatives are necessary for further improvement, especially to improve antibiotic guideline adherence on Aruba.


    Fig 1: Aruba - the Netherlands


    Table 1: score QIs

    QI

    Baseline

    (n = 150)

    Intervention 

    (n =173)

    Comparison

    numerator/

    denominator

    numerator/

    denominator

    Difference %

    OR*

    CI (95%)

    P

    Blood cultures

    22/150

    119/173

    + 54

    13.7

    7.7-24.2

    <0.001

    Cultures of suspected site of infection

    33/68

    41/99

    - 7

    0.69

    0.4-1.3

    0.27

    Guideline adherence

    67/109

    79/138

    - 4

    0.84

    0.5-1.4

    0.51

    Adjustment to renal function

    6/16

    12/23

    + 15

    1.84

    0.5-6.8

    0.36

    Documented antibiotic plan

    116/150

    154/173

    + 12

    1.75

    0.9-3.4

    0.10

    De-escalation

    15/53

    21/77

    - 10

    1.07

    0.5-2.2

    0.85

    IV-oral switch

    29/85

    41/98

    + 8

    1.67

    0.6-2.2

    0.64

    SUMSCORE ≥ 50%

    75/150

    134/173

    + 27

    3.42

    2.1-5.7

    <0.001

    *after correction for confounders

     

    Frederike V. Van Daalen, MD1, Anouk Lagerburg, BSc1, Jaclyn De Kort, MD2, Elena Sánchez-Rivas, MD2, Jan M. Prins, Professor, MD1, Brent C. Opmeer, PhD1, Marlies E.J.L. Hulscher, Professor3 and Suzanne E. Geerlings, Professor, MD1, (1)Academic Medical Center, Amsterdam, Netherlands, (2)dr. Horacio E. Oduber Hospitaal, Oranjestad, Aruba, (3)Radboud University Medical Center, Nijmegen, Netherlands

    Disclosures:

    F. V. Van Daalen, None

    A. Lagerburg, None

    J. De Kort, None

    E. Sánchez-Rivas, None

    J. M. Prins, None

    B. C. Opmeer, None

    M. E. J. L. Hulscher, None

    S. E. Geerlings, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.