title: The Reduction in Antibiotic Use in Hospitals.
abstract: BACKGROUND
  Over 350 000 patients are treated in German hospitals for sepsis or pneumonia each year. The rate of antibiotic use in hospitals is high. The growing problem of drug resistance necessitates a reconsideration of antibiotic treatment strategies.
  
  
  METHODS
  Antibiotics were given liberally in the years 2010 and 2011 in a German 312-bed hospital. Special training, standardized algorithms to prevent unnecessary drug orders, and uniform recommendations were used in 2012 and 2013 to lessen antibiotic use. We retrospectively studied the hospital's mortality figures and microbiological findings to analyze how well these measures worked.
  
  
  RESULTS
  Antibiotic consumption fell from 67.1 to 51.0 defined daily doses (DDD) per 100 patient days (p <0.001) from the period 2010-2011 to the period 2012-2013. The mortality of patients with a main diagnosis of sepsis fell from 1% (95/305) to 19% (63/327; p = 0.001), while that of patients with a main diagnosis of pneumonia fell from 12% (22/178) to 6% (15/235; p = 0.038). The overall mortality fell from 3.0% (623/ 20 954) to 2.5% (576/22 719; p = 0.005). In patients with nosocomial urinary tract infections with Gram-negative pathogens (not necessarily exhibiting three- or fourfold drug resistance), the rate of resistance to three or four of the antibiotics tested fell from 11% to 5%.
  
  
  CONCLUSIONS
  Reducing in-hospital antibiotic use is an achievable goal and was associated in this study with lower mortality and less drug resistance. The findings of this single-center, retrospective study encourage a more limited and focused approach to the administration of antibiotics.
authors.affiliation: Internal Medicine and Intensive Care Medicine, Asklepios Hospital Schildautal, Seesen, Clinic for Cardiology, Pneumology, Angiology and Internal Intensive Medicine (Medical Clinic I), Uniklinik RWTH Aachen, Central Department of Hospital Hygiene and Infectiology, Uniklinik RWTH Aachen, Institute for Medical Microbiology, School of Medicine, University of Göttingen, Hospital Pharmacy, Asklepios Harz Hospitals, Goslar, Hospital Pharmacy, KRH Hanover Regional Hospital Group, Hanover.
authors.forename: Karen
authors.initials: K
authors.lastname: Scholze
authors.forename: Mechthild
authors.initials: M
authors.lastname: Wenke
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schierholz
authors.forename: Uwe
authors.initials: U
authors.lastname: Groß
authors.forename: Oliver
authors.initials: O
authors.lastname: Bader
authors.forename: Ortrud
authors.initials: O
authors.lastname: Zimmermann
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lemmen
authors.forename: Jan R
authors.initials: JR
authors.lastname: Ortlepp
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000401:mortality* / Q000517:prevention & control*; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000401:mortality* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D000067490:Prescription Drug Overuse / Q000401:mortality / Q000517:prevention & control* / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents