scholarly journals 842. Impact of Active Treatment of Carbapenem-Resistant Acinetobacter baumannii Infections in US Hospitals Between 2014 and 2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S462-S462
Author(s):  
Jason M Pogue ◽  
Yun Zhou ◽  
Hemanth Kanakamedala ◽  
Bin Cai
Keyword(s):  
Antibiotic Therapy ◽  
Acinetobacter Baumannii ◽  
Active Treatment ◽  
Panel Member ◽  
Readmission Rates ◽  
Independent Contractor ◽  
In Vitro Susceptibility ◽  
Carbapenem Resistant ◽  
Discharge Status ◽  
The Impact

Abstract Background Treatment choices for carbapenem-resistant (CR) Acinetobacter baumannii infections are limited. We analyzed the impact of active treatment on outcomes in patients infected with CR vs carbapenem-susceptible (CS) A. baumannii. Methods Adult patients hospitalized between January 1, 2014 and June 30, 2019 with A. baumannii infections recorded in the Premier Database were retrospectively evaluated. Outcomes including mortality, discharge status (home vs other), and readmission rates were calculated as a function of receipt of active antibiotic treatment, infection site, and CR status. Antibiotic therapy was considered active if given after the index culture and displaying in vitro susceptibility. Results Among 3,500 patients with A. baumannii (CR n=1,608; CS n=1,892), 2,057 patients (58.8%) received active treatment, with a much lower proportion of CR A. baumannii patients receiving active treatment than CS patients (606 [37.7%] vs 1,451 [76.7%]). Patients without active treatment had similar rates of in-hospital mortality (14.3% vs 12.9%, P=0.25) but were less likely to be discharged to home (26.3% vs 37.0%, P< 0.001) than those that received active treatment. No association between receipt of active treatment and overall mortality or discharged status was demonstrated for CR isolates (Table 1). However, among the subset of patients with CR bloodstream infections, mortality was higher in those without active treatment compared to those with active treatment (55.1% vs 25.9%, P=0.009). Overall readmission rates due to A. baumannii were considerably higher for those who did not receive active treatment vs those who did (16.0% vs 7.5%, P< 0.001) and the same was seen by differing infection sites; primarily driven by CR patients with bloodstream, respiratory, or urine infections (Table 2). Table 1. Mortality and discharge status by active treatment and carbapenem susceptibility Table 2. Readmission due to A. baumannii by active treatment and CR status among patients discharged alive Conclusion Active antibiotic therapy was associated with improved outcomes in patients with A. baumannii infections, although perhaps not to the extent expected. Further investigation into the impact of active therapy on outcomes is warranted. Disclosures Jason M Pogue, PharmD, BCPS, BCIDP, Shionogi Inc. (Advisor or Review Panel member) Yun Zhou, MS, Shionogi Inc. (Independent Contractor) Hemanth Kanakamedala, BS, Shionogi Inc. (Independent Contractor) Bin Cai, MD, PhD, Shionogi Inc. (Employee)

scholarly journals 848. Trends of Carbapenem Resistance in Enterobacterales in the US Between 2015 and 2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S464-S464
Author(s):  
Stephen Marcella ◽  
Hemanth Kanakamedala ◽  
Yun Zhou ◽  
Bin Cai ◽  
Jason M Pogue
Keyword(s):  
Treatment Options ◽  
Panel Member ◽  
Carbapenem Resistance ◽  
Patient Characteristics ◽  
Independent Contractor ◽  
Healthcare Database ◽  
Patient Demographics ◽  
Carbapenem Resistant ◽  
Low Incidence ◽  
The Impact

Abstract Background Carbapenem-resistant Enterobacterales (CRE) are considered an urgent threat to human health by the CDC. Tracking resistance over time is of importance to understand trends and patterns. Tracking carbapenem resistance is complicated by definitions which include resistance to ertapenem only which can differ in epidemiology, mechanism, and treatment options. This study examines trends of CRE from 2015 to 2019 and the impact of carbapenem resistance on outcomes. Methods Enterobacterales infections identified in the Premiere HealthCare database from 2015 to 2019 were categorized into 3 groups: ertapenem only resistant (Erta-R); isolates resistant to ertapenem and class 2 carbapenems (CR-1/2); and carbapenem susceptible (CS). Trends in resistance over the study period were assessed. Furthermore, patient characteristics and outcomes were compared between groups. Results Among 225,457 unique cultures 692 were Erta-R, 2,397 were CRE-1/2, and 222,368 were CS. Overall rates of CRE-1/2 slightly increased from 0.9% to 1.2% over the study period (P for trend of < 0.0001) while there was a slight negative trend for Erta-R rates (P for trend =0.006). Rates of CR by pathogen (Figures 1 and 2) were relatively stable over the study period. Enterobacter cloacae was the most common organism in the Erta-R group and K. pneumoniae was the most common CRE-1/2 pathogen. Differences in patient characteristics were seen between the three groups for race, gender, and comorbidities (Table). Both mortality (Erta-R: 10%, CRE-1/2: 9% vs CS: 4%, respectively) and infection-associated length of stay (Erta-R: 8 days; CRE-1/2: 8 days vs CS: 6 days, respectively) were higher in both Erta-R and CRE 1/2 when compared to CS (P< 0.001). There were no differences in outcomes between patients with Erta-R and CRE 1/2. Figure 1. Annual rates of CRE (resistance to both classes) by pathogen over the study period Figure 2. Annual rates of CRE (ertapenem R only) by pathogen over the study period Table. Patient demographics and outcomes Conclusion CRE rates were relatively stable over the study period. Despite low incidence, CRE continue to have significant associations with morbidity and mortality. Interestingly, outcomes were similar in patients with isolates resistant to ertapenem only when compared to isolates resistant to both classes of carbapenems. This might be reflective of novel treatment options available over the study period. Disclosures Stephen Marcella, MD, Shionogi Inc. (Employee) Hemanth Kanakamedala, BS, Shionogi Inc. (Independent Contractor) Yun Zhou, MS, Shionogi Inc. (Independent Contractor) Bin Cai, MD, PhD, Shionogi Inc. (Employee) Jason M Pogue, PharmD, BCPS, BCIDP, Shionogi Inc. (Advisor or Review Panel member)

Carbapenem Resistance, Initial Antibiotic Therapy, and Mortality inKlebsiella pneumoniaeBacteremia: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 38 (11) ◽  
pp. 1319-1328 ◽  
Author(s):  
Philipp P. Kohler ◽  
Cheryl Volling ◽  
Karen Green ◽  
Elizabeth M. Uleryk ◽  
Prakesh S. Shah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antibiotic Therapy ◽  
Meta Analysis ◽  
Carbapenem Resistance ◽  
Carbapenem Resistant ◽  
Initial Antibiotic Therapy ◽  
Meta Regression ◽  
The Difference ◽  
Meta Regression Analysis ◽  
The Impact

BACKGROUNDMortality associated with infections caused by carbapenem-resistantEnterobacteriaceae(CRE) is higher than mortality due to carbapenem-sensitive pathogens.OBJECTIVETo examine the association between mortality from bacteremia caused by carbapenem-resistant (CRKP) and carbapenem-sensitiveKlebsiella pneumoniae(CSKP) and to assess the impact of appropriate initial antibiotic therapy (IAT) on mortality.DESIGNSystematic review and meta-analysisMETHODSWe searched MEDLINE, EMBASE, CINAHL, and Wiley Cochrane databases through August 31, 2016, for observational studies reporting mortality among adult patients with CRKP and CSKP bacteremia. Search terms were related toKlebsiella, carbapenem-resistance, and infection. Studies including fewer than 10 patients per group were excluded. A random-effects model and meta-regression were used to assess the relationship between carbapenem-resistance, appropriateness of IAT, and mortality.RESULTSMortality was higher in patients who had CRKP bacteremia than in patients with CSKP bacteremia (15 studies; 1,019 CRKP and 1,148 CSKP patients; unadjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.8–2.6; I2=0). Mortality was lower in patients with appropriate IAT than in those without appropriate IAT (7 studies; 658 patients; unadjusted OR, 0.5; 95% CI, 0.3–0.8; I2=36%). CRKP patients (11 studies; 1,326 patients; 8-year period) were consistently less likely to receive appropriate IAT (unadjusted OR, 0.5; 95% CI, 0.3–0.7; I2=43%). Our meta-regression analysis identified a significant association between the difference in appropriate IAT and mortality (OR per 10% difference in IAT, 1.3; 95% CI, 1.0–1.6).CONCLUSIONSAppropriateness of IAT is an important contributor to the observed difference in mortality between patients with CRKP bacteremia and patients with CSKP bacteremia.Infect Control Hosp Epidemiol2017;38:1319–1328

scholarly journals 1590. Updated Aminoglycoside (AG) MIC Breakpoints (BP) to Minimize Adverse Events and Improve Outcome: Impact on Susceptibility (S) Rates

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S580-S580
Author(s):  
Michael A Pfaller ◽  
Robert K Flamm ◽  
Paul G Ambrose ◽  
David Andes ◽  
John S Bradley ◽  
...  
Keyword(s):  
The United States ◽  
Drug Combinations ◽  
In Vitro Susceptibility ◽  
Safety And Efficacy ◽  
Improve Outcome ◽  
The Third ◽  
Carbapenem Resistant ◽  
Vestibular Toxicity ◽  
The Impact

Abstract Background In 2016 USCAST, the National Advisory Committee (NAC) for the United States (US) to EUCAST, undertook the re-evaluation of the in vitro susceptibility (AST) test interpretive criteria (IC) for gentamicin (GM), tobramycin (TO) and amikacin (AK) against Enterobacteriaceae (ENT), P. aeruginosa (PSA) and S. aureus (SA) based on an analysis of contemporary microbiology and PK/PD data. In 2019 USCAST posted the third version (www.uscast.org) of AG IC document and CLSI and EUCAST has published AG IC in CLSI M100-S29 and EUCAST v 9.0 documents. USCAST ICs for S were generally lower than those proposed by CLSI for all organism/drug combinations. PK/PD emphasized high, extended interval dosing (5 renal function groups) to reduce nephro-vestibular toxicity and a stasis exposure endpoint. Here, we evaluate the impact on S rates for US AST data that these IC changes created. Methods Clinical isolates from 2010 to 2018 US SENTRY Program (reference broth microdilution AST) were analyzed for S based on current and previous IC values. AG results for GM, TO and AK were evaluated against 66,280 ENT, 13,959 PSA and 51,950 SA. Benchmark S data for meropenem, cefepime, piperacillin–tazobactam and new AG, plazomicin (PZM) were included as well as ESBL and carbapenem-resistant ENT (CRE; 805 isolates). Results S rates for ENT as determined by USCAST IC were reduced by 4.2/1.2/3.1% for AK/GM/TO (CLSI) and by 3.3% for AK (EUCAST); no S rate difference for GM and TO as determined by USCAST/EUCAST. For PSA, S decreased by 46.8/6.2% for AK/TO (EUCAST) and 51.6/6.2% (CLSI). S for SA vs. GM declined by only 0.2% (CLSI). No AG IC could be calculated/offered for Acinetobacter or GM X PSA or AM/TO X SA. Best S overall coverage X ESBL (99.2%) or CRE (97.2%) isolates was by PZM. Conclusion USCAST IC updates for AG lead to reduced values for some organism/drug combinations among ENT and PSA compared with those proposed elsewhere. The USCAST-recommended ICs were based on achieving AUC/MIC ratio target associated with net bacterial stasis. Given the assumption of AG combination therapy, stasis was considered a reasonable endpoint when evaluating AG ICs to improve both safety and efficacy. Some organism X drug exposures could not be calculated and lower IC for pneumonia isolates (GM, TO) was recommended. Disclosures All authors: No reported disclosures.

scholarly journals Mathematical Model To Quantify the Effects of Risk Factors on Carbapenem-Resistant Acinetobacter baumannii

2014 ◽  
Vol 58 (9) ◽  
pp. 5239-5244 ◽  
Author(s):  
Michelle W. Tan ◽  
David C. Lye ◽  
Tat-Ming Ng ◽  
Michael Nikolaou ◽  
Vincent H. Tam
Keyword(s):  
Risk Factors ◽  
Linear Regression ◽  
Acinetobacter Baumannii ◽  
Antibiotic Consumption ◽  
Model Fit ◽  
Defined Daily Dose ◽  
Content Type ◽  
Carbapenem Resistant ◽  
The Impact ◽  
Over Time

ABSTRACTCarbapenem-resistantAcinetobacter baumannii(CRAB) infections are increasing, and they are associated with an increased risk of mortality in hospitalized patients. Linear regression is commonly used to identify concurrent trends, but it cannot quantify the relationship between risk factors and resistance. We developed a model to quantify the impact of antibiotic consumption on the prevalence of CRAB over time. Data were collected from January 2007 to June 2013 from our institution. Quarterly antibiotic consumption was expressed as defined daily dose/1,000 inpatient days. Six-month prevalence of CRAB was expressed as a percentage of all nonrepeatA. baumanniiisolates tested. Individual trends were identified using linear regression. Antibiotic consumption from 2007 to 2011 was input as a step function in a relationship with CRAB. Model fit was evaluated by visual inspection and the residual sum of squares. The final model was validated using the best-fit (95% confidence interval) parameter estimates and antibiotic consumption to predict CRAB prevalence from January 2012 to June 2013. Cefepime, ertapenem, and piperacillin-tazobactam consumption and CRAB prevalence increased significantly over time. CRAB prevalence was best correlated to ertapenem (use sensitive;r2= 0.76), and accounting for additional concurrent antibiotic use did not significantly improve model fit. Prospective validation with ertapenem consumption correlated well with CRAB observations, suggesting good predicting ability of the model. Our model provided the quantitative impact of antibiotic consumption on CRAB. We plan to further refine this model to account for multiple risk factors. Interventions should focus on controlling risk factors with the highest impact on resistance.

Clinical and economic outcomes attributable to carbapenem-resistant Enterobacterales and delayed appropriate antibiotic therapy in hospitalized patients

2021 ◽  
pp. 1-11
Author(s):  
Kirati Kengkla ◽  
Yuttana Wongsalap ◽  
Natthaya Chaomuang ◽  
Pichaya Suthipinijtham ◽  
Peninnah Oberdorfer ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Mortality Rates ◽  
Hospitalized Patients ◽  
Economic Outcomes ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Medication Costs ◽  
The Impact

Abstract Objective: To assess the impact of carbapenem resistance and delayed appropriate antibiotic therapy (DAAT) on clinical and economic outcomes among patients with Enterobacterales infection. Methods: This retrospective cohort study was conducted in a tertiary-care medical center in Thailand. Hospitalized patients with Enterobacterales infection were included. Infections were classified as carbapenem-resistant Enterobacterales (CRE) or carbapenem-susceptible Enterobacterales (CSE). Multivariate Cox proportional hazard modeling was used to examine the association between CRE with DAAT and 30-day mortality. Generalized linear models were used to examine length of stay (LOS) and in-hospital costs. Results: In total, 4,509 patients with Enterobacterales infection (age, mean 65.2 ±18.7 years; 43.3% male) were included; 627 patients (13.9%) had CRE infection. Among these CRE patients, 88.2% received DAAT. CRE was associated with additional medication costs of $177 (95% confidence interval [CI], 114–239; P < .001) and additional in-hospital costs of $725 (95% CI, 448–1,002; P < .001). Patients with CRE infections had significantly longer LOS and higher mortality rates than patients with CSE infections: attributable LOS, 7.3 days (95% CI, 5.4–9.1; P < .001) and adjusted hazard ratios (aHR), 1.55 (95% CI, 1.26–1.89; P < .001). CRE with DAAT were associated with significantly longer LOS, higher mortality rates, and in-hospital costs. Conclusion: CRE and DAAT are associated with worse clinical outcomes and higher in-hospital costs among hospitalized patients in a tertiary-care hospital in Thailand.

scholarly journals 523. Dual vs. Triple Antibiotic Therapy for Carbapenem-Resistant Acinetobacter baumannii Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S252-S252
Author(s):  
Justin Patrick Markelwith ◽  
Nikunj M Vyas ◽  
Mark Condoluci ◽  
Sungwook Kim
Keyword(s):  
Combination Therapy ◽  
Serum Creatinine ◽  
Antibiotic Therapy ◽  
Acinetobacter Baumannii ◽  
Clinical Cure ◽  
Group Analysis ◽  
Elevated Serum ◽  
Positive Association ◽  
Primary Analysis ◽  
Carbapenem Resistant

Abstract Background Infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) remain some of the most difficult to treat due to extremely high rates of resistance. The purpose of this study was to compare the efficacy of dual vs. triple targeted antibiotic regimens for CRAB infections. Methods This was an IRB approved retrospective cohort study performed at a 607-bed community health system between January 2016 and December 2018. Patients were included in the analysis if they were ≥18 years old and received antibiotics for CRAB for ≥72 hours. Patients were excluded if they were pregnant and had CRAB isolated solely from the urine. The primary endpoints of the study were differences in all-cause in-hospital mortality (ACIM) and clinical cure (CC) rates for patients treated with dual vs. triple antibiotic therapy. The secondary endpoint result focused on the difference in length of stay (LOS) between treatment groups. A sub-group analysis was performed for patients treated with tigecycline vs. minocycline combination therapy to determine differences ACIM and CC, and LOS. A multi-logistic regression analysis (MLRA) was performed to determine patient factors that were associated with ACIM and CC. Results A total of 32 patients were included in the primary analysis. No difference was seen in ACIM between dual vs. triple antibiotic groups (9.5% vs. 18.2%, P = 0.59). CC (63.6% vs. 57.1%, P = 1.0) and LOS (12 vs. 11 days, P = 1.0) was similar amongst patients treated with dual vs. triple antibiotic group. No differences were seen in ACIM (15.4% vs. 16.7% P = 1.0), CC (83.3% vs. 69.2%, P = 1.0) and LOS (15 vs. 14 days, P = 1.0) between tigecycline and minocycline combination therapy groups. The MLRA revealed a positive association with increased serum creatinine and ACIM (OR 3.29, 95% CI 1.35–8.04; P = 0.009) as well as shorter time to appropriate antibiotic therapy and clinical cure (OR 1.49, 95% CI 1.02–2.20; P = 0.04). CRAB isolates were more likely to be susceptible to minocycline vs. tigecycline (83% vs. 18%, P = 0.003). Conclusion No differences were seen in ACIM, CC and LOS between dual vs. triple antibiotic groups. Minocycline tends to sustain better susceptibility toward CRAB vs. tigecycline. Elevated serum creatinine was found to be a predictor for ACIM while shorter time to appropriate antibiotic therapy was associated with CC. Disclosures All authors: No reported disclosures.

scholarly journals 551. Burden of Illness in Carbapenem-Resistant Acinetobacter baumannii Infections in US Hospitals (2014 to 2018)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S262-S262
Author(s):  
Jason M Pogue ◽  
Hemanth Kanakamedala ◽  
Yun Zhou ◽  
Bin Cai
Keyword(s):  
Acinetobacter Baumannii ◽  
Burden Of Illness ◽  
Positive Culture ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Patient Characteristics ◽  
Healthcare Database ◽  
Carbapenem Resistant ◽  
Discharge Status ◽  
High Level

Abstract Background Infections caused by Acinetobacter baumannii present a challenge for treating physicians due to the high level of antimicrobial resistance. The current analysis compared the burden of illness in patients infected with carbapenem-resistant (CR) vs. -susceptible (CS) strains of A. baumannii. Methods Hospitalized adult patients with microbiologically confirmed A. baumannii infections (defined as a positive culture and receipt of antibiotics between 2 days prior to 3 days after the culture) included in the Premier Healthcare Database were retrospectively evaluated. Patient characteristics including demographics, comorbidities, time of infection onset and site of infection were assessed. Comparative outcomes between CR and CS patients assessed included in-hospital mortality, length of hospital stay (LOS), ICU LOS, and discharge status. Outcomes were also stratified by site of infection. Results A total of 3,471 patients admitted between January 1, 2014 and June 30, 2018 were included. Patients with CR strains of A. baumannii were older (62 vs. 59 years), more likely to have Charlson Comorbidity Index ≥3 (63.4% vs. 56.1%), more likely admitted from a healthcare origin (30.3% vs. 11.4%) and less likely to have the onset of infection within first 48 hours of hospitalization (58% vs. 69%) than those with CS strains. CR patients had increased inpatient mortality compared with CS patients (16.3% vs. 11.0%), driven primarily by patients with bloodstream infections (42.6% vs. 12.4%, respectively, P < 0.001). CR patients had a non-significantly increased median overall LOS from the onset of infection (9 vs. 8 days, P = 0.068), were more likely to be admitted to the ICU, and were significantly less likely to be discharged home (16% vs. 47%, P < 0.001). Hospitalization charges were considerably higher for CR patients (table). Readmission rates were high among CR patients and were similar to patients with CS infections. Conclusion Patients with CR strains of A. baumannii face a greater burden of illness compared with CS patients, experiencing increased mortality, ICU admission and LOS, and incur higher hospitalization charges. Furthermore, CR patients were less likely to be discharged home after admission. Disclosures All authors: No reported disclosures.

Do Results of Surveillance Cultures Impact the Choice of Empirical Antibiotics Among Patients with Carbapenem-Resistant Acinetobacter baumannii Infections?

2015 ◽  
Vol 36 (12) ◽  
pp. 1455-1457
Author(s):  
Rossana Rosa ◽  
Jose Castro ◽  
Rachel Latibeaudiere ◽  
Nicholas Namias ◽  
L. Silvia Munoz-Price
Keyword(s):  
Antibiotic Therapy ◽  
Acinetobacter Baumannii ◽  
Infect Control Hosp ◽  
Empirical Antibiotic Therapy ◽  
Carbapenem Resistant ◽  
Surveillance Cultures ◽  
Empirical Antibiotics

We aimed to determine whether the results of surveillance cultures were associated with use of appropriate empirical antibiotic therapy among patients with carbapenem-resistant Acinetobacter baumannii infections. We found that surveillance status was not associated with appropriate empirical antibiotic therapy (P=.36). There were significant delays to concordant therapy among surveillance-positive patients (P=.03).Infect. Control Hosp. Epidemiol. 2015;36(12):1455–1457

scholarly journals Impact of an antimicrobial stewardship programme on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitals in Jordan

2020 ◽  
Author(s):  
Dawood Yusef ◽  
Wail A Hayajneh ◽  
Ali Bani Issa ◽  
Rami Haddad ◽  
Sayer Al-Azzam ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Antibiotic Use ◽  
Broad Spectrum Antibiotic ◽  
Carbapenem Resistant ◽  
Restriction Policy ◽  
Prior Approval ◽  
Tertiary Teaching ◽  
The Impact

Abstract Objectives To evaluate the impact of an antimicrobial stewardship programme (ASP) on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitalized patients. Methods The study was a retrospective, ecological assessment in a tertiary teaching hospital over 6 years (January 2014 to December 2019). The intervention involved the implementation of an ASP in February 2018, which remains in effect today. This ASP consists of several components, including education, antibiotic guidelines, antibiotic restriction policy with prior approval, audit of compliance to the restriction policy and feedback. Restricted antibiotics were imipenem/cilastatin, ertapenem, meropenem, vancomycin, teicoplanin, tigecycline, colistin, amikacin, piperacillin/tazobactam, levofloxacin and ciprofloxacin. The intervention was evaluated by time-series methods. Results Statistically significant decreases in the level of antibiotic use, after the introduction of the ASP, were observed for the following antibiotics: imipenem/cilastatin (P = 0.0008), all carbapenems (P = 0.0001), vancomycin (P = 0.0006), colistin (P = 0.0016) and third-generation cephalosporins (P = 0.0004). A statistically significant decrease in the slope, after the introduction of the ASP, for ertapenem (P = 0.0044) and ciprofloxacin (P = 0.0117) was observed. For piperacillin/tazobactam, there was a significant increasing trend (P = 0.0208) before the introduction of the ASP. However, this increased trend was halted post-introduction of the ASP (P = 0.4574). The introduction of the ASP was associated with a significant impact on reducing the levels of CRAb (P = 0.0237). Conclusions The introduced antimicrobial stewardship interventions contributed to a reduction in the use of several broad-spectrum antibiotics, reversed the trends of increasing use of other antibiotics and were associated with a significant reduction in CRAb.

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