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Background: The high prevalence of carbapenem-resistant Klebsiella imposes optimizing antibiotic consumption. We aimed to evaluate the impact of antibiotic stewardship program on carbapenem consumption and the Klebsiella resistance. Method: We retrospectively evaluated critically ill patients with isolated Klebsiella species from Elaraby hospital, Egypt during the period from April 2017 to January 2019. We collected data related to carbapenems consumption and Klebsiella clinical isolates with their antimicrobial susceptibility. Based on susceptibility, Klebsiella isolates were classified into sensitive, extended spectrum beta-lactamase (ESBL) producer, and carbapenem-resistant Klebsiella (CRK), respectively. Our primary outcome was the change in carbapenems consumption after implementing the program, while the secondary outcomes were the changes in the incidence of CRK. 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 carbapenems consumption from 38.9 to 26.6 defined daily dose/1000 patient-days (p = 0.02). The incidence of CRK 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 of 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. [ABSTRACT FROM AUTHOR]

Background: It has been demonstrated that patients with three-vessel coronary artery disease respond better to coronaryartery bypass grafting (CABG) than to percutaneous coronary intervention (PCI). Aim of the Study: To compare the incidence of significant adverse cardiac or cerebrovascular events in patients with threevessel coronary artery disease between fractional flow reserve (FFR) -guided PCI using current-generation drug-eluting stents and CABG. Patients and methods: One hundred patients with three-vessel coronary artery disease, identified angiographically and not involving the left main coronary artery, were included in this randomized prospective clinical study. This study comprised 100 patients who were randomly assigned into two groups: Group I: 50 patients underwent FFR-guided PCI. Group II: 50 patients underwent CABG. Results: The CABG group received an average of 3.7 distal anastomoses, with 34% receiving multiple arterial grafts and 92% receiving a left internal thoracic artery graft. The primary endpoint of MACCE was lower in the FFR-guided PCI group (6%) compared to the CABG group (10%). Secondary endpoints like death, spontaneous MI, stroke, and revascularization were generally higher in the CABG group, while target vessel revascularization was higher in the PCI group. Regarding safety, the PCI group had a significantly lower incidence of BARC type 3-5 bleeding (2% vs 16%) and atrial fibrillation (10% vs 28%) compared to CABG. Acute kidney injury and 30-day rehospitalization rates were insignificantly different between the groups. Conclusion: The FFR-guided PCI group had a lower incidence of MACCE at 6% compared to 10% in the CABG group. [ABSTRACT FROM AUTHOR]