Effect of Antimicrobial Stewardship Program on Carbapenems Consumption and Klebsiella Resistance in the Intensive Care Units

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.