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

Abstract

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 extendedspectrum 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