High prevalence of extended-spectrum β-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India
Ashish Pathak1,2, Yogyata Marothi3, Vandana Kekre4, Kalpana Mahadik5, Ragini Macaden6, Cecilia Stålsby Lundborg1
1Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 2Department of Pediatrics, 3Department of Microbiology, 4Department of Medicine, 5Department of Obstetrics and Gynecology, RD Gardi Medical College, Ujjain, India; 6St Johns Research Institute, Bangalore, India
Background: Recent reports of the rapid evolution of bacterial resistance in India require urgent antibiotic stewardship programs. This study aimed to define the magnitude and pattern of resistance of bacterial pathogens to guide empirical therapy.
Methods: We prospectively collected consecutive, clinically significant, and nonduplicate bacterial isolates from each patient from two hospitals in Ujjain, India. The antibiotic susceptibility of the bacteria was tested using a disc diffusion method as recommended by the Clinical and Laboratory Standards Institute.
Results: A total of 716 pathogens were isolated from 2568 patients (median age, 25 years; range, 0 days to 92 years). Gram-negative infections were predominant (62%). The isolated pathogens included Staphylococcus aureus (n = 221; 31%), Escherichia coli (n = 149; 21%), Pseudomonas aeruginosa (n = 127; 18%), and Klebsiella pneumoniae (n = 107; 15%). Common diagnoses included abscesses (56%), urinary tract infections (14%), blood stream infections (10%), pneumonia (10%), and vaginal infections (10%). In E. coli isolates, 69% (95% confidence interval [CI] 61.6–76.6) were extended-spectrum β-lactamase (ESBL) producers and 41% (95% CI 31.6–50.5) of K. pneumoniae isolates were ESBL producers. These isolates had a high resistance to fluoroquinolones and β-lactams, except for imipenem and piperacillin-tazobactam. Salmonella typhi remained sensitive to third-generation cephalosporins. Methicillin-resistant S. aureus (MRSA) constituted 30% of all S. aureus isolates and showed resistance to ciprofloxacin (81%), cotrimoxazole (76%), and levofloxacin (60%).
Conclusion: Our results showed a high prevalence of ESBL among Gram-negative bacterial isolates and a high prevalence of MRSA among S. aureus isolates. Carbapenems provided the broadest coverage for Gram-negative bacteria, while glycopeptides were the most effective against MRSA; however, both classes of drugs need to be used judiciously. This study will help in planning future antibiotic stewardship programs.
Keywords: antibiotic susceptibility, surveillance, extended-spectrum β-lactamases, India
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]
Readers of this article also read:
Carr ME, Tortella BJ
Published Date: 3 September 2015
Relapsed Hodgkin lymphoma in adolescents: focus on current high-dose chemotherapy and autologous stem cell transplant
Guilcher GM, Stewart DA
Published Date: 8 May 2014
Prozorova GF, Pozdnyakov AS, Kuznetsova NP, Korzhova SA, Emel’yanov AI, Ermakova TG, Fadeeva TV, Sosedova LM
Published Date: 16 April 2014
Ashwanikumar N, Kumar NA, Nair SA, Kumar GS
Published Date: 15 November 2012
Deepa G, Thulasidasan AK, Anto RJ, Pillai JJ, Kumar GS
Published Date: 27 July 2012
Published Date: 8 December 2011
Particle size reduction to the nanometer range: a promising approach to improve buccal absorption of poorly water-soluble drugs
Rao S, Song Y, Peddie F, Evans AM
Published Date: 20 June 2011
Published Date: 17 September 2010
Pitipol Choopong, Nattaporn Tesavibul, Nattawut Rodanant
Published Date: 14 July 2010
Characterization of complexation of poly (N-isopropylacrylamide-co-2-(dimethylamino) ethyl methacrylate) thermoresponsive cationic nanogels with salmon sperm DNA
Jim Moselhy, Tasnim Vira, Fei-Fei Liu, et al
Published Date: 24 August 2009