P094: Impact of antibiotics changes on the incidence of bloodstream infection due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an Algerian neonatal intensive care unit

Introduction

Klebsiella pneumoniae is one of the most common nosocomial bloodstream infection (BSI) pathogens in neonatal intensive care units (NICUs) of developing countries. Its ability to produce extended-spectrum beta-lactamases (ESBLs) has caused great concern worldwide. Early studies reported that high beta-lactam antibiotic consumption was an independent risk factor for acquisition of ESBL-producing K. pneumoniae BSI.

Objectives

The objective of this study was to examine the impact of the reduction of beta-lactam antibiotic consumption on the incidence of ESBL-producing K. pneumoniae BSI in an Algerian NICU.

Methods

A comprehensive education campaign was undertaken in the University Hospital of Blida NICU in the beginning of 2008 to reduce the beta-lactam antibiotic consumption in this unit. To measure the impact of this campaign on the incidence of ESBL-producing K. pneumoniae BSI, a prospective surveillance of healthcare-associated BSI was performed from 2008 to 2010 using National Nosocomial Infection Surveillance (NNIS) System criteria. Antibiotic consumption was measured by dividing the total days of beta-lactam antibiotic consumption by the total days of patients NICU stay.

Results

From 2008 to 2010, a total of 3842 neonates who remained in the NCIU for more than 48 hours were included in the study. These patients had total patient-days of 44,424 and total beta-lactam antibiotic-days of 25,180. Beta-lactam antibiotic consumption decreased significantly from 71.4 antibiotic-days per 100 patient-days in 2008 to 41.3 antibiotic-days per 100 patient-days in 2010 (p < .01). Incidence of ESBL-producing K. pneumoniae BSI decreased significantly from 3.6% in 2008 to 0.2% in 2010 (p < .01), and incidence density decreased significantly from 3.2 per 1000 patient-days in 2008 to 0.2 per 1000 patient-days in 2010 (p<.01).

Conclusion

Our findings highlight the need to minimise unnecessary and inappropriate antimicrobial use (specifically that of beta-lactam antibiotics) to prevent the acquisition of ESBL-producing K. pneumoniae BSI in the NICUs of developing countries.

Disclosure of interest

None declared