In-hospital antibiotic stewardship From evidence to action

This thesis addresses the growing global threat of Antimicrobial resistance, which undermines the effectiveness of antibiotics despite historically successful treatment of infectious diseases. Although resistance levels in Netherlands remain relatively low, increasing multidrug resistance and a rising population of immunocompromised patients highlight the urgency of optimizing antibiotic use. Antimicrobial Stewardship programs aim to improve antibiotic prescribing practices, yet inappropriate use persists, necessitating better evidence, monitoring tools, and education.
The thesis is divided into two parts: generating evidence and translating it into practice. Part I evaluates appropriate antibiotic use. It demonstrates that standard dosing for pleural infections achieves adequate drug levels for common Gram-positive pathogens but is insufficient for certain Gram-negative bacteria. An umbrella review further shows that shorter antibiotic courses are effective for common respiratory infections in clinically stable patients, though evidence quality is frequently low and evidence gaps remain for specific conditions.
Part II focuses on implementation. Semi-automated extraction of electronic health record data proved largely accurate in identifying antibiotic use and duration, offering a practical monitoring tool. However, challenges remain in reliably determining treatment indications, with both manual and automated methods showing limitations. A clinical intervention on a haematology ward demonstrated that stewardship strategies can safely reduce antibiotic exposure and promote narrower-spectrum use without compromising patient outcomes. Finally, evaluation of an international training program confirmed that structured education effectively equips healthcare professionals to implement stewardship interventions. Overall, the thesis highlights that combining evidence-based strategies, robust data systems, and targeted education is essential to sustain effective antibiotic use and combat AMR.