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PLoS One. 2013 Dec 9;8(12):e79747. doi: 10.1371/journal.pone.0079747. eCollection 2013.

Antibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates.

Author information

1
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
2
National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa ; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa ; Division of Medical Microbiology, University of Stellenbosch, Cape Town, South Africa.
3
National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa ; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
4
Quality Assurance, Groote Schuur Hospital, Cape Town, South Africa.
5
Pharmacy, Groote Schuur Hospital, Cape Town, South Africa.
6
Department of General Medicine, University of Cape Town, Cape Town, South Africa.
7
Division of General Internal Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.

Abstract

BACKGROUND:

Antibiotic consumption is a major driver of bacterial resistance. To address the increasing burden of multi-drug resistant bacterial infections, antibiotic stewardship programmes are promoted worldwide to rationalize antibiotic prescribing and conserve remaining antibiotics. Few studies have been reported from developing countries and none from Africa that report on an intervention based approach with outcomes that include morbidity and mortality.

METHODS:

An antibiotic prescription chart and weekly antibiotic stewardship ward round was introduced into two medical wards of an academic teaching hospital in South Africa between January-December 2012. Electronic pharmacy records were used to collect the volume and cost of antibiotics used, the patient database was analysed to determine inpatient mortality and 30-day re-admission rates, and laboratory records to determine use of infection-related tests. Outcomes were compared to a control period, January-December 2011.

RESULTS:

During the intervention period, 475.8 defined daily doses were prescribed per 1000 inpatient days compared to 592.0 defined daily doses/1000 inpatient days during the control period. This represents a 19.6% decrease in volume with a cost reduction of 35% of the pharmacy's antibiotic budget. There was a concomitant increase in laboratory tests driven by requests for procalcitonin. There was no difference in inpatient mortality or 30-day readmission rate during the control and intervention periods.

CONCLUSIONS:

Introduction of antibiotic stewardship ward rounds and a dedicated prescription chart in a developing country setting can achieve reduction in antibiotic consumption without harm to patients. Increased laboratory costs should be anticipated when introducing an antibiotic stewardship program.

PMID:
24348995
PMCID:
PMC3857167
DOI:
10.1371/journal.pone.0079747
[Indexed for MEDLINE]
Free PMC Article

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