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.

Background: There is an urgent need to improve health outcomes among severe COVID-19 patients. Therefore, this study aimed to demystify efficacy and safety of tocilizumab among those patients based on the best available evidence. Methods: Nine electronic databases were searched for relevant studies by three authors in July using search terms “tocilizumab”, “COVID”, “SARS”. The last date checked was 26 August, 2020. Eligible studies were assessed through an inclusion criterion focused on cohort studies and severe COVID-19 adult patients. Any disagreement between the authors was resolved by discussions. Primary outcomes were mortality and clinical improvement, while secondary outcomes were tocilizumab-related adverse effects. Results: Tocilizumab reduced the mortality rate by 41%, 40%, 28%, and 37% in 7, 14, 21, and 28 days. There was neither statistically significant difference between the tocilizumab group and the control group in the clinical improvement (pooled risk ratio1.21 [0.89, 1.64]) nor in respiratory support change. There were no difference between the two groups in the occurrence of serious adverse events (pooled risk difference 0.00 [-0.02, 0.03]), bacteremia (pooled risk ratio 1.25 [0.80, 1.97]), elevation of liver functions (pooled risk difference -0.00 [-0.03, 0.02]) and infusion related reactions (pooled risk difference 0.01 [-0.02, 0.03]). However, the occurrence of neutropenia (pooled risk ratio 9.23 [1.06, 80.24]) and new infections (pooled risk difference 0.07 [0.00, 0.14]) were more likely in the tocilizumab group. Conclusion: Because of the reported adverse effects of tocilizumab in treating severe COVID-19 patients, the use of that biological agent should be limited to selected patients based on the best available evidence.