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Introduction: Antibiotic stewardship programs (ASP) are designed to optimize antibiotic use in hospitals. Antibiotic consumption is one of the measures assessing the effects of ASPs., Aims: To evaluate the effect of an ASP on antibiotic consumption in our hospital and compare it to hospitals in Israel and worldwide., Methods: Between October 2012 and March 2013 an ASP was implemented in Rambam Hospital. The program included educational activities, publication of local guidelines for empirical antibiotic treatment, structured infectious diseases consultations, pre-authorization antibiotic restrictions and stop orders. We compared antibacterial antibiotic consumption in defined daily doses (DDD)/100 hospital days (HD) between the periods before (1/2010-3/2013) and after (4/2013-9/2014) implementing the ASP. The study was conducted in the medical departments, hematology, the intensive care unit (ICU) and all pediatric wards., Results: Total antibiotic consumption before implementing the ASP was 96±11.2 DDD/100 HD in medical departments, 186.4±42.8 in the ICU and 185.5±59 in hematology; all values were higher than the worldwide-reported averages for these departments. Following the ASP, total antibiotic consumption decreased by 12% (p=0.008) in the medical departments and by 26% (p=0.002) in hematology, mostly due to reductions in non-restricted antibiotics. No significant changes were observed overall in the ICU and in pediatric wards. There was a significant reduction in consumption of vancomycin and carbapenems in all settings, the latter was reduced to nearly half. Amikacin use quadrupled in the medical departments., Conclusions: Implementation of an ASP lead to a reduction in non-restricted and restricted antibiotic consumption, especially carbapenems.

This is an unusual case report of an elderly patient with spontaneous acute rupture of rotator cuff complicated by large subacromial hematoma. The hematoma fluid was aspirated with significant reduction of pain. The shoulder movements were restored after one month with conservative therapy. The compensatory role of preserved deltoid muscle is considered in the rehabilitation of normal shoulder movement, which may replace aggressive immobilization or surgical procedures in the elderly population. Investigation of hematoma fluid compared with blood 24 hours after the event revealed severe lactic acidosis with low glucose level, preserved red blood cell count and significant decrease of white blood cells. There were normal values of CBC, pH, lactate and glucose in blood. These results showed high susceptibility of leukocytes to anaerobic and acid environment and its dependence on oxygen supplement.