BackgroundInappropriate use of antimicrobials is one of the core contributors to antimicrobial resistance. While hospitals create high selection pressures on bacteria due to the high quantity and broader spectrum of antibiotics used, information on antimicrobial use at the patient level in the Caribbean is sparse. In response, PAHO implemented a standardized WHO methodology to engage national leaderships, build local capacity, and facilitate the use of data to inform antimicrobial stewardship programs (ASP) in the Caribbean.MethodsPoint prevalence surveys (PPS) were performed in four acute care hospitals in Barbados, Guyana and Saint Lucia between June and July 2018. Medical records of all inpatients were reviewed to collect information on antibiotic use, indications and use of laboratory services (Figure 1). A hospital questionnaire was used to assess hospital infrastructure, policy and practices, and monitoring and feedback systems (Figure 2). Training on PPS methods and electronic data collection tool in REDCap™ were provided to build local capacity and identify potential ASP leaderships. A standardized data validation, analysis and reporting system was built in R to streamline the process. Results and recommendations were disseminated to national authorities and stakeholders to support hospital and national decision-making and training for healthcare providers (Figure 3).ResultsA total of 60 physicians, nurses, pharmacists, laboratory technicians, and infection control specialists were trained and participated in the PPS. The survey collected records of 816 patients in which 442 (54%) were females and 374 (46%) were males. In total, 356 (44%) patients received 551 antibiotics. Overall, 300 (75%) of 398 indications for antibiotic use were treatment and 72 (18%) were prophylaxis. A higher use of parenteral antibiotics (79%) was observed compared with oral antibiotics (21%). Antibiotic prescribing patterns differed across hospitals. The most commonly used antibiotics were metronidazole (12%) and amoxicillin/clavulanate (11%).ConclusionThe PPS method provided a feasible and effective way to collect baseline data and identify target areas for interventions. Engaging national leaderships and building local capacity offered a sustainable way in optimizing antimicrobial use in resource-limited settings. Disclosures All authors: No reported disclosures.

Objective. To describe the epidemiology of human leptospirosis cases in Saint Lucia from 2010 to 2017 and determine whether there was a relationship between cases and rainfall and temperature. Methods. A retrospective analytical study was undertaken to describe the seasonal patterns of human leptospirosis cases reported to the Ministry of Health of Saint Lucia between 2010 and 2017. Confirmed cases of leptospirosis were analyzed according to age, sex, seasonality, and geographical distribution. Disease incidence was calculated and the association of cases with geographical distribution, rainfall, and temperature was investigated. Results. A total of 353 leptospirosis cases were reported between 2010 and 2017 and of these, 145 (40.6%) were laboratory confirmed. Cases were aged 7 to 73 years (mean 34 years; median 30 years) with a male to female ratio of 4.2:1. Six deaths were reported during the period, with an overall case fatality rate of 4.1%. There was no relationship between location (district) and incidence of leptospirosis in Saint Lucia. There was a weak correlation between rainfall and leptospirosis cases during the 8-year period (rs = 0.25, p = 0.015) but the correlation between cases and seasons was not statistically significant (dry season rs = 0.13, p = 0.42; wet season rs = 0.23, p = 0.08). There was no correlation between leptospirosis cases and temperature (rs = 0.07, p = 0.49). Conclusions. Leptospirosis has a seasonal distribution in Saint Lucia, with outbreaks during periods following increased rainfall and flooding, such as in the aftermath of tropical storms and hurricanes. Saint Lucia and other Caribbean countries should enhance surveillance for leptospirosis given the likelihood of increased flooding following frequent and intense rainfall due to climate change.