# Correlation Between Antimicrobial Consumption and Resistance in Klebsiella pneumoniae During the COVID-19 Pandemic Using Dynamic Regression Models: A Quasi-Experimental Epidemiological Time-Series Study

## TL;DR

This study examines how antibiotic use during the COVID-19 pandemic affected resistance in Klebsiella pneumoniae using time-series data and dynamic models.

## Contribution

The novel use of dynamic regression models to quantify the link between antibiotic consumption and resistance during the pandemic in K. pneumoniae.

## Key findings

- AMC of cephalosporins and fluoroquinolones correlated with increased resistance in K. pneumoniae.
- Aminoglycoside resistance was largely explained by increased consumption of the same class.
- Pandemic-related changes in antibiotic use were linked to resistance trends in K. pneumoniae.

## Abstract

Background/Objectives: The COVID-19 pandemic has been reported to impact antimicrobial consumption (AMC) and antimicrobial resistance (AMR) worldwide. We aimed to assess this correlation in Klebsiella pneumoniae before and during the COVID-19 pandemic and to estimate the burden of each antibiotic. Methods: We collected data on AMC of penicillins and beta-lactamase inhibitors (PBIs), anti-pseudomonal activity penicillins and beta-lactamase inhibitors (AAPBIs), cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, and AMR in K. pneumoniae strains. The correlation between AMC and AMR was studied using dynamic regression models. Results: Overall, AMC of AAPBIs and fourth-generation cephalosporin increased, while fluoroquinolone consumption and AMR in the 2862 K. pneumoniae strains analyzed decreased. However, during the first year of the pandemic, we reported an increase in AMC and AMR. We found that 46% to 48% of the increase in cephalosporin, AAPBI, and fluoroquinolone resistance was explained by increased cephalosporin and fluoroquinolone consumption, 55% of the increase in PBI resistance was explained by increased PBI, cephalosporin, and fluoroquinolone consumption, and 58% of the increase in aminoglycoside resistance was explained by increased aminoglycoside consumption. Conclusions: During the COVID-19 pandemic, the increase in AMR in K. pneumoniae was correlated with the increase in AMC of several antibiotics, mainly cephalosporins and especially fluoroquinolones.