Introduction: The prevalence of carbapenem-resistant Klebsiella strains
and their related mortality are increasing worldwide. These pandemics
impose optimizing antibiotic consumption through the application of the
antibiotic stewardship programs. We aimed to evaluate the impact of
applying antibiotic stewardship programs on carbapenem consumption and
the klebsiella resistance pattern in critically ill patients of a large
Egyptian hospital. Method: We retrospectively evaluated critically ill
patients with isolated Klebsiella species from the ICU of Elaraby
hospital, Egypt during the period from April 2017 to January 2019. We
collected data related to carbapenem consumption (expressed as defined
daily dose /1000 patient-days) and Klebsiella clinical isolates and
their antimicrobial susceptibility pattern. Based on Klebsiella
sensitivity, as sensitive to ceftriaxone and cefotaxime, resistant to
ceftriaxone/cefotaxime, or resistance to meropenem/imipenem, Klebsiella
isolates were classified as grades 1, 2, or 3, respectively. Our primary
outcome was the change in carbapenem consumption after implementing the
program, while the secondary outcomes were the change in the incidence
of carbapenem-resistant Klebsiella. Results: The study included 205
patients with isolated Klebsiella species during the study period. The
antibiotic stewardship program started in March 2018. Out of the 205
patients, 61 patients (29.8%) represented the pre-intervention sample,
and 144 patients (70.2%) represented the post-intervention sample.
Applying the antibiotic stewardship program was associated with a
significant decrease in the carbapenem consumption from 38.9 to 26.6
defined daily dose /1000 patient-days (P=0.02). The incidence of
carbapenem-resistant Klebsiella was decreased from 85.25% of total
Klebsiella isolates to 48.6% (P<0.001). Klebsiella species
were more likely to be in a lower category of resistance after applying
the program with an odds ratio (OR) = 6.3 (2.88-13.73) using ordinal
logistic regression. Conclusion: Applying the antibiotic stewardship
program could reduce the unnecessary carbapenems use in the ICU with a
subsequent decrease in the emergence of the Klebsiella resistant
strains.
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