Carbapenems consumption and Klebsiellaresistance in intensive care units in Egypt: A study to evaluate the effect of an antimicrobial stewardship program

Background The high prevalence of carbapenem-resistant Klebsiellaimposes optimizing antibiotic consumption. We aimed to evaluate the impact of antibiotic stewardship program on carbapenem consumption and the Klebsiellaresistance.Method We retrospectively evaluated critically ill patients with isolated Klebsiellaspecies from Elaraby hospital, Egypt during the period from April 2017 to January 2019. We collected data related to carbapenems consumption and Klebsiellaclinical isolates with their antimicrobial susceptibility. Based on susceptibility, Klebsiellaisolates 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 Klebsiellaspecies 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 Klebsiellaisolates to 48.6% (p< 0.001). Klebsiellaspecies 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.