2.3. Antimicrobial stewardship program:
The program consists of three main parts: (1) Interventional part
including preauthorization of restricted antibiotics list by clinical
pharmacy specialists and primary physician, antibiotic timeout to
reassess empiric antibiotics use 48-72 hours after their initiation,
dosing optimization (based on patient-specific drug clearance, the
volume of distribution, infection site, and microbiological factors),
and managing the antibiotics-related problems, (2) Designing and
implementing hospital-specific guidelines and antimicrobial policies,
(3) Educational part including education of health-care professionals
regarding antibiotics administration and handling.
2.4. Bacterial isolates:
Blood samples were transferred into brain heart infusion broth,
incubated at 35 Co for 5 days, and if any turbidity
was observed, it was transferred into MacConkey agar and blood agar.
Sputum samples were inoculated in MacConkey agar, blood agar, and
chocolate agar. Swab samples were inoculated in MacConkey agar and blood
agar.
2.5. Klebsiella identification:
The Klebsiella isolates obtained in MacConkey agar showed large,
highly mucoid, and pink colonies. Microscopic examination with gram
stain showed short gram-negative rods. Confirmation forKlebsiella was performed using biochemical reactions (Hansen,
Aucken, Abiola, & Podschun, 2004).
These include Kligler’s Iron Agar
(KIA) test, Lysine iron agar (LIA) test, Motility indole ornithine (MIO)
test, Citrate test, and Urease test.
2.6. Antibiotic susceptibility:
The antibiotic susceptibility using the disc diffusion method was
performed with Mueller Hinton agar and discs from
Oxoid®, United Kingdom and based on Kirby-Bauer
technique (Bauer, 1966) and the cut-off values for clear zones set by
The Clinical & Laboratory Standards Institute (CLSI) recommendations
and standards 2018 (In, 2018). The test discs were ceftriaxone 30 ηg,
cefotaxime 30 ηg, ceftazidime 30 ηg, meropenem 10 ηg, and imipenem 10
ηg.
Klebsiella isolates were classified into three grades according
to antibiotics susceptibility: grade 1 which are
sensitive to ceftriaxone and
cefotaxime, grade 2 which resist
ceftriaxone/cefotaxime, and grade
3 including strains resistant to meropenem/imipenem
(carbapenem-resistant Klebsiella (CRK))