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

<b>Background/Objectives</b>: The COVID-19 pandemic has been reported to impact antimicrobial consumption (AMC) and antimicrobial resistance (AMR) worldwide. We aimed to assess this correlation in <i>Klebsiella pneumoniae</i> before and during the COVID-19 pandemic and to estimate the burden of each antibiotic. <b>Methods</b>: 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 <i>K. pneumoniae</i> strains. The correlation between AMC and AMR was studied using dynamic regression models. <b>Results</b>: Overall, AMC of AAPBIs and fourth-generation cephalosporin increased, while fluoroquinolone consumption and AMR in the 2862 <i>K. pneumoniae</i> 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. <b>Conclusions</b>: During the COVID-19 pandemic, the increase in AMR in <i>K. pneumoniae</i> was correlated with the increase in AMC of several antibiotics, mainly cephalosporins and especially fluoroquinolones.