Decades of injudicious antibiotic prescribing and a disregard for basic infection control practice have left the international community facing a return to the age of untreatable bacterial infections. The rise of extended spectrum beta-lactamase (ESBL)-producing bacteria and subsequently carbapenemase-resistant strains has left colistin as the sole antibiotic in the armamentarium for these infections, an antibiotic from the 1960s with a high toxicity profile. Colistin resistance has already been reported, rendering some patients untreatable. The recent identification and subsequent spread of New Delhi Metallo-beta-lactamase-1 (NDM-1) and Klebsiella pneumonia carbapenemase (kpc)-producing Enterobacteriaceae signify the latest ‘super-bugs’ to threaten public health. The number of NDM-1 infections in Gauteng is rising rapidly with spread to other South African cities. South Africa needs a strong, coordinated, and urgent response to this threat. Clinical governance of antibiotic prescribing (antibiotic stewardship) through dedicated programmes and infection control practice must be strengthened if we are to control the situation.
The South African Antibiotic Stewardship Programme will:
Accepting that public and private sector healthcare presents different health structures and challenges, the working group resolved to engage the following key stakeholders: