title: Sustained reduction in antibiotic consumption in a South African public sector hospital; Four year outcomes from the Groote Schuur Hospital antibiotic stewardship program.
abstract: BACKGROUND
  Overuse of antibiotics has driven global bacterial resistance to the extent that we have entered a post-antibiotic era, where infections that were once easily treatable are now becoming untreatable. Efforts to control consumption have focused on antibiotic stewardship programmes (ASPs), aimed at optimising use.
  
  
  OBJECTIVE
  To report antibiotic consumption and cost over 4 years from a public hospital ASP in South Africa (SA).
  
  
  METHODS
  A comprehensive ASP comprising online education, a dedicated antibiotic prescription chart and weekly dedicated ward rounds was introduced at Groote Schuur Hospital, Cape Town, in 2012. Electronic records were used to collect data on volume and cost of antibiotics and related laboratory tests, and to determine inpatient mortality and 30-day readmission rates. These data were compared with a control period before the intervention.
  
  
  RESULTS
  Total antibiotic consumption fell from 1 046 defined daily doses/1 000 patient days in 2011 (control period) to 868 by 2013 and remained at similar levels for the next 2 years. This was driven by reductions in intravenous antibiotic use, particularly ceftriaxone. Inflation-adjusted cost savings on antibiotics were ZAR3.2 million over 4 years. Laboratory tests increased over the same period with a total increased cost of ZAR0.4 million. There was no significant change in mortality or 30-day readmission rates.
  
  
  CONCLUSIONS
  The effects of a comprehensive ASP on medical inpatients at a public sector hospital in SA were durable over 4 years, leading to a reduction in total antibiotic consumption without adverse effect. When increased laboratory costs were offset there was a net cost saving of ZAR2.8 million.
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa. tomboyles@yahoo.com.
authors.forename: T H
authors.initials: TH
authors.lastname: Boyles
authors.forename: V
authors.initials: V
authors.lastname: Naicker
authors.forename: N
authors.initials: N
authors.lastname: Rawoot
authors.forename: P J
authors.initials: PJ
authors.lastname: Raubenheimer
authors.forename: B
authors.initials: B
authors.lastname: Eick
authors.forename: M
authors.initials: M
authors.lastname: Mendelson
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy; D001431:Bacteriological Techniques / Q000191:economics* / Q000706:statistics & numerical data; D019411:Clinical Laboratory Techniques / Q000191:economics* / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing / Q000379:methods*; D006779:Hospitals, Public; D006784:Hospitals, Teaching; D006801:Humans; D009026:Mortality; D010359:Patient Readmission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013019:South Africa
chemical_list: D000900:Anti-Bacterial Agents