Implementation of an Antibiotic Stewardship Program to Increase Appropriate Antibiotic Use in the Hospital on Aruba

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