1
|
Peters AC, Larsson DGJ, Laxminarayan R, Munthe C. Barriers and pathways to environmental surveillance of antibiotic resistance in middle- and low-income settings: a qualitative exploratory key expert study. Glob Health Action 2024; 17:2343318. [PMID: 38813982 PMCID: PMC11141306 DOI: 10.1080/16549716.2024.2343318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 04/11/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Local and global surveillance of antibiotic resistance (ABR) has proven a challenge to implement effectively in low- and middleincome (LMI) settings. Environmental surveillance solutions are increasingly highlighted as a strategy to help overcome such problems, and thus to promote global health as well as the local management of ABR in LMI countries. While technical and scientific aspects of such solutions are being probed continuously, no study has investigated their practical feasibility. OBJECTIVE Explore practical barriers for environmental surveillance of ABR in LMI countries, and pathways for surveillance experts to manage these. METHODS To start charting this unknown territory, we conducted an explorative, qualitative interview study with key informants, applying a constructivist grounded theory approach to analyze the results. RESULTS Barriers were identified across infrastructural, institutional and social dimensions, and pathways to manage them were mostly counterproductive from an ABR management perspective, including avoiding entire regions, applying substandard methods and failing to include local collaborators. CONCLUSION The research community as well as international agencies, organizations and states have key roles and responsibilities for improving the prospects of feasible environmental ABR surveillance in LMI-settings.
Collapse
Affiliation(s)
- Ann-Christin Peters
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), Gothenburg, Sweden
| | - D. G. Joakim Larsson
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), Gothenburg, Sweden
- Department of Infectious Diseases, Institute for Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Ramanan Laxminarayan
- One Health Trust, Washington, DC, USA
- One Health Trust, Bangalore, India
- High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
| | - Christian Munthe
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), Gothenburg, Sweden
| |
Collapse
|
2
|
Adhyaru HJ, Mangroliya DB, Bhalu AB, Kabariya JH, Ramani VM. Genomic insights into prevalence of virulence and multi drug resistance genes in milk borne Klebsiella pnuemoniae: Face of emerging resistance to last resort antibiotics. Microb Pathog 2024; 196:106936. [PMID: 39270756 DOI: 10.1016/j.micpath.2024.106936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 09/02/2024] [Accepted: 09/10/2024] [Indexed: 09/15/2024]
Abstract
Spread of hypervirulent and multi-drug resistant Klebsiella pneumoniae in raw milk is public health concern due to its potential impact on food safety and public health. Therefore, this study investigated antibiotic susceptibility test (AST), antibiotic resistance genes (ARGs), mutations conferring ARGs, virulence factor and plasmid replicons to check prevalence of fosfomycin resistant MDR K. pneumoniae isolated from raw milk samples collected from Saurashtra region of Gujarat, India. K. pneumoniae isolated from raw milk and subjected to disk diffusion assay. From that, MDR along with fosfomycin resistant isolates were analysed for multi locus sequence typing, presence of ARGs, mutations conferring resistance, virulence factors and plasmid replicon types by using its whole genome sequence. Results shows that, among 32 K. pneumoniae, 8 were phenotypically resistant to fosfomycin. As per WGS analysis, 8 MDR isolates were assigned into different sequence types such as ST3321, ST37, ST2715, ST1087, ST3157, ST299 and ST29. Among that, ST37 is well recognized MDR high risk clone reported worldwide and first time reported from raw milk of Saurashtra region of Gujarat, India. ARGs responsible for resistance to fosfomycin (fosA) were found in all 8 isolates. Other ARGs such as blaSHV, kdeA, OqxA, OqxB, dfrA1, sul1, qnrB4, aadA2 and ere(A) were also detected. High diversity of virulence factors was also identified by detection of genes encoding virulence factors related to iron uptake such as entE, fepD, entA, entB, Irp2, fepG, ybtU, ybtP, fepC, ybtA, ybtE, fepB, ybtS, fyuA, ybtQ, ybtT, ybtX, Irp1, adherence such as yagZ/ecpA, yagV/ecpE, yagX/ecpC, yagV/ecpE, ykgK/ecpR and invasion such as fimA, pla, fimC, fimH, fimB, fimE were detected in eight genomes. Mutations in murA, uhpT and glpT conferring a fosfomycin resistance were also present in genomes of 8 K. pneumoniae. IncF was the most common plasmid replicon type detected in all 8 genomes. The study reports high diversity of virulent and multidrug resistant K. pneumoniae in raw milk. Hence, genomic surveillance plans are urgently required for food borne pathogens.
Collapse
Affiliation(s)
- Hetvi J Adhyaru
- Department of Dairy Microbiology, College of Dairy Science, Kamdhenu University, Amreli, Gujarat, India
| | - Devangi B Mangroliya
- Department of Dairy Microbiology, College of Dairy Science, Kamdhenu University, Amreli, Gujarat, India
| | - Arti B Bhalu
- Department of Dairy Microbiology, College of Dairy Science, Kamdhenu University, Amreli, Gujarat, India
| | - Jayesh H Kabariya
- Department of Dairy Microbiology, College of Dairy Science, Kamdhenu University, Amreli, Gujarat, India
| | - Vimal M Ramani
- Department of Dairy Microbiology, College of Dairy Science, Kamdhenu University, Amreli, Gujarat, India.
| |
Collapse
|
3
|
Tilahun M, Sharew B, Shibabaw A. Antimicrobial resistance profile and associated factors of hospital-acquired gram-negative bacterial pathogens among hospitalized patients in northeast Ethiopia. BMC Microbiol 2024; 24:339. [PMID: 39261762 PMCID: PMC11389124 DOI: 10.1186/s12866-024-03485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 09/02/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Antimicrobial resistance is a major global public health issue. Infections caused by resistant species are associated with higher mortality rates, longer hospital stays, medication failure, and rising medical costs. The World Health Organisation has declared multidrug resistance-associated infections as an epidemic of public health concern. OBJECTIVE This study aimed to evaluate the antimicrobial resistance profile and associated factors of hospital-acquired Gram-negative bacterial pathogens among hospitalized patients in Northeast Ethiopia. MATERIALS AND METHODS A health facility-based cross-sectional study was conducted among hospitalized patients from March 2021 to February 2022. About 810 clinical specimens were collected, transported, and processed from admitted patients following the standard bacteriological procedures. The clinical samples were inoculated onto blood agar, MacConkey agar, and chocolate agar. Furthermore, the species identification was done using gram reactions, colony morphology, and color and biochemical tests. Antimicrobial susceptibility tests, extended-spectrum beta-lactamase, and carbapenemase production were performed as per the clinical laboratory standard institute guidelines. For analysis, the information was entered into Epi-data and exported to SPSS. A P value of < 0.05 with a 95% confidence interval was considered as a statistically significant association. RESULTS Out of 810 clinical specimens, 285/810 (35.2%) developed bacterial infections. From the isolated bacteria, E. coli was the predominant bacteria accounting for 78/285 (27.4%) followed by K. pneumoniae, 69/285(24.42%), whereas P. vulgaris accounted for the least, 7/285 (2.5%). Overall, 132/285 (46.3%) and 99/285 (34.7%) of culture-positive patients were infected by extended-spectrum beta-lactamase and carbapenemase-producing bacteria. The overall multidrug resistance rate of the isolated bacteria was 89.4%. The highest antibiotic resistance rates were detected for doxycycline (92.9%), amoxicillin-clavulanic acid (83.9%), and ampicillin (93%). The least antibiotic resistance rate was observed for meropenem at 41.1% and amikacin at 1.7%, respectively. CONCLUSIONS AND RECOMMENDATIONS In the study area, significant health concerns include a range of hospital-acquired bacterial infections associated with elevated rates of multidrug resistance, Extended-spectrum beta-lactamase (ESBL), and carbapenemase-producing bacterial pathogens. Consequently, it is recommended to conduct drug-susceptibility testing of isolates and molecular detection at a national level to optimize antibiotic usage for treating prevalent bacterial infections in this area.
Collapse
Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, 1145, Ethiopia.
| | - Bekele Sharew
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre-Tabor, Ethiopia
| | - Agumas Shibabaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, 1145, Ethiopia
| |
Collapse
|
4
|
Vogiantzi G, Metallinou D, Tigka M, Deltsidou A, Nanou CI. Bloodstream Infections in the Neonatal Intensive Care Unit: A Systematic Review of the Literature. Cureus 2024; 16:e68057. [PMID: 39347186 PMCID: PMC11438544 DOI: 10.7759/cureus.68057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2024] [Indexed: 10/01/2024] Open
Abstract
Bloodstream infections represent a significant concern in neonatal intensive care units (NICUs), constituting a leading cause of morbidity and mortality among neonates. This study aimed to elucidate the etiology, prevalence, and antimicrobial resistance patterns of bloodstream infections in NICU settings. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines using the PubMed database to source relevant studies published between 2019 and 2023. Keywords related to bloodstream infections, neonates in NICUs, pathogens, resistance, and susceptibility were employed. Out of the 73 identified articles, eight met the inclusion criteria. Findings revealed a predominance of late-onset sepsis in hospitalized neonates, with Escherichia coli, Klebsiella pneumoniae, coagulase-negative staphylococci, Group B Streptococcus, Acinetobacter species, Serratia marcescens, Staphylococcus aureus, and Enterobacter cloacae being the most commonly isolated pathogens. Antimicrobial susceptibility profiles demonstrated resistance among bacteria to ampicillin, gentamicin, and penicillin, while fungi exhibited resistance to amphotericin B, fluconazole, flucytosine, itraconazole, and voriconazole. These findings underscore the persistent challenge of bloodstream infections in the NICUs, particularly late-onset sepsis, emphasizing the importance of early detection and appropriate antimicrobial therapy in neonatal care management.
Collapse
Affiliation(s)
- Georgia Vogiantzi
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Dimitra Metallinou
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Maria Tigka
- Department of Midwifery, General and Maternity Hospital "Helena Venizelou", Athens, GRC
| | - Anna Deltsidou
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Christina I Nanou
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, GRC
| |
Collapse
|
5
|
Ghosh S. Polymyxin B Plus Aerosolized Colistin vs Polymyxin B Alone in Hospital-acquired Pneumonia ("AEROCOL" Study): A Feasibility Study. Indian J Crit Care Med 2024; 28:792-795. [PMID: 39239172 PMCID: PMC11372667 DOI: 10.5005/jp-journals-10071-24767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/10/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction In hospital-acquired pneumonia (HAP) due to extensively drug resistant gram-negative pathogens, can treatment with high-dose colistin aerosolization using specific aerosol delivery protocol, improve clinical outcome in addition to systemic polymyxin-B? Materials and methods In a randomized control trial, invasively ventilated adult ICU patients with HAP in whom clinicians decided to start systemic polypeptide antibiotics, were randomized to receive either intravenous polymyxin-B plus high-dose colistin nebulization (5-MIU 8-hourly) using specific protocol or intravenous polymyxin-B alone. Results The study was closed early after recruiting 60% of planned patients because of slow rate of recruitment (24 patients in over 30 months). Treatment success (Primary outcome) was nonsignificantly higher in intervention group (63.66 vs 30.77%; p = 0.217). There was higher rate of microbiological cure in intervention group (60 vs 9.09%: p = 0.018). Numerically better secondary outcomes including fever-free days, ventilator- or vasopressor free days at day-7, ICU and hospital mortality also did not reach statistical significance. Two episodes of transient hypoxia were seen during aerosol delivery. However, overall incidences of adverse effects were not different between groups. Conclusion This study could not confirm superiority of high-dose colistin aerosolization plus systemic polymyxin-B strategy over polymyxin-B alone in treating HAP due to extensive drug resistance (XDR) gram-negative pathogens. How to cite this article Ghosh S. Polymyxin B Plus Aerosolized Colistin vs Polymyxin B Alone in Hospital-acquired Pneumonia ("AEROCOL" Study): A Feasibility Study. Indian J Crit Care Med 2024;28(8):792-795.
Collapse
Affiliation(s)
- Supradip Ghosh
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| |
Collapse
|
6
|
Aboushady AT, Manigart O, Sow A, Fuller W, Ouedraogo AS, Ebruke C, Babin FX, Gahimbare L, Sombié I, Stelling J. Surveillance of Antimicrobial Resistance in the ECOWAS Region: Setting the Scene for Critical Interventions Needed. Antibiotics (Basel) 2024; 13:627. [PMID: 39061309 PMCID: PMC11273779 DOI: 10.3390/antibiotics13070627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance poses a significant challenge to public health globally, leading to increased morbidity and mortality. AMR surveillance involves the systematic collection, analysis, and interpretation of data on the occurrence and distribution of AMR in humans, animals, and the environment for action. The West African Health Organization, part of the Economic Community of West African States (ECOWAS), is committed to addressing AMR in the region. This paper examines the status of AMR surveillance in ECOWAS countries using available WHO data from the TrACSS survey and GLASS enrollments. The analysis reveals that while progress has been made, significant challenges remain. Twelve of the fifteen ECOWAS countries are enrolled in GLASS, and ten have developed national action plans (NAPs) for AMR. However, there is a need to ensure all countries fully implement their NAPs, continue reporting to GLASS, and use the data for evidence-based actions and decision making. Surveillance systems for AMR and antimicrobial consumption/use vary across countries with some demonstrating limited capacity. All countries, except Cabo Verde, reported having a reference laboratory for AMR testing. Strengthening laboratory capabilities, data management and use, and multisectoral coordination are crucial for effective AMR surveillance and response. Based on the findings and the regional context, it is essential to prioritize capacity building, data utilization, and the adoption of standardized guidelines for AMR surveillance. Collaboration among ECOWAS countries, the WAHO, and international partners is essential to address AMR comprehensively. Ensuring a consistent supply of essential antimicrobial medications and reagents is vital.
Collapse
Affiliation(s)
| | - Olivier Manigart
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- GFA Consulting Group, 22359 Hamburg, Germany
- Ecole de Santé Publique, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Abdourahmane Sow
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- Institut Pasteur de Dakar, Dakar 220, Senegal
- Department de Santé Public, Faculté de Médecine, de Pharmacie et D’Odontostomatologie, Université Cheikh Anta Diop, Dakar 5005, Senegal
| | - Walter Fuller
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (W.F.); (L.G.)
| | - Abdoul-Salam Ouedraogo
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso 01 BP 390, Burkina Faso;
| | - Chinelo Ebruke
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- GFA Consulting Group, 22359 Hamburg, Germany
| | | | - Laetitia Gahimbare
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (W.F.); (L.G.)
| | - Issiaka Sombié
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
| | - John Stelling
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| |
Collapse
|
7
|
Kaur J, Singh H, Sethi T. Emerging trends in antimicrobial resistance in bloodstream infections: multicentric longitudinal study in India (2017-2022). THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 26:100412. [PMID: 38757091 PMCID: PMC11097075 DOI: 10.1016/j.lansea.2024.100412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
Background Antimicrobial resistance (AMR) has escalated to pandemic levels, posing a significant global health threat. This study examines the patterns and trends of AMR in Bloodstream Infections (BSIs) across India, aiming to inform better surveillance and intervention strategies. Methods Six-year data from 21 tertiary care centers in the Indian Council of Medical Research's AMR Surveillance Network (IAMRSN) were retrospectively analyzed to estimate cluster-robust trends in resistance. Time-series analysis was used to discern lead/lag relationships between antibiotic pairs and the directional influence of resistance in community and hospital-acquired BSIs(CA/HA BSIs). A data-driven Bayesian network ensemble averaged over 301 bootstrap samples was modelled to uncover systemic associations between AMR and Sustainable Development Goals (SDGs). Findings Our findings indicate significant (p < 0.001) monthly increases in Imipenem and Meropenem resistance for Klebsiella, E. coli, and Acinetobacter BSIs. Importantly, Carbapenem resistance in HA-BSIs preceded that in CA-BSIs for Klebsiella and Acinetobacter (p < 0.05). At a national level, Cefotaxime resistance emerged as a potential early indicator for emerging Carbapenem resistance, proposing a novel surveillance marker. In Klebsiella BSIs, states with higher achievement of SDG3 goals showed lower Imipenem resistance. A model-based AMR scorecard is introduced for focused interventions and continuous monitoring. Interpretation The identified spatiotemporal trends and drug resistance associations offer critical insights for AMR surveillance aligning with WHO GLASS standards.The escalation of carbapenem resistance in BSIs demands vigilant monitoring and may be crucial for achieving SDGs by 2030. Implementing the proposed framework for data-driven evidence can help nations achieve proactive AMR surveillance. Funding No specific funding was received for this analysis.
Collapse
Affiliation(s)
- Jasmine Kaur
- Center of Excellence in Healthcare, Indraprastha Institute of Information Technology Delhi, New Delhi, India
- Department of Computational Biology, Indraprastha Institute of Information Technology Delhi, New Delhi, India
- Division of Biomedical Informatics, Indian Council of Medical Research, Delhi, India
| | - Harpreet Singh
- Division of Biomedical Informatics, Indian Council of Medical Research, Delhi, India
| | - Tavpritesh Sethi
- Center of Excellence in Healthcare, Indraprastha Institute of Information Technology Delhi, New Delhi, India
- Department of Computational Biology, Indraprastha Institute of Information Technology Delhi, New Delhi, India
| |
Collapse
|
8
|
Bhuvaraghan A, King R, Walley J, Thiruvenkatachari B, Aggarwal VR. Dental antibiotic policies, stewardship, and implementation in India: A policy document analysis. Community Dent Oral Epidemiol 2024. [PMID: 38887900 DOI: 10.1111/cdoe.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 05/10/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Dental antibiotic stewardship is crucial in low- and middle-income countries where the burden of antimicrobial resistance (AMR) is high and antibiotic misuse is common. Given that India is the most populous country, the largest antibiotic consumer and has a large dental prescriber population, this study investigated the extent to which current Indian policy and practice for dental antibiotic prescribing and stewardship aligns with the global policy and best practice. METHODS The READ approach was used to identify and extract data and synthesize the findings. Policy documents on dental antimicrobial stewardship were identified using a systematic search strategy involving nine medical and grey literature databases (Medline, Global Health, Web of Science, Cochrane, CINAHL, Eldis, Global Index Medicus, Proquest and Opengrey), targeted websites (government organizations and dental regulatory bodies) and contact with experts. Framework analysis was used to code extracted data into themes related to dental antimicrobial stewardship. RESULTS Of the 3039 records screened, 25 documents were included in the final analysis. The analysis showed a lack of guidelines or toolkits for appropriate antibiotic prescribing in dentistry in India. The treatment guidelines for antimicrobial use in common syndromes published by the Indian Council of Medical Research had no section or content for dental practitioners. Furthermore, the undergraduate dental curriculum developed by the Dental Council of India (DCI), included little content on appropriate antibiotic prescribing and no mention of AMR or stewardship. There were no educational resources either for dental practitioners or patients in the documents. CONCLUSION This document analysis showed that there was little or no mention of dental antibiotic prescribing guidelines in key policy documents such as the National Action Plan on AMR. In addition, contradictory and subjective information provided in some policy documents could encourage dentists and other health professionals such as general practitioners to prescribe antibiotics for common dental conditions for which they are contra-indicated. There is an urgent need to develop relevant guidelines and include these in Indian policy documents on AMR particularly the National Action Plan on AMR.
Collapse
Affiliation(s)
- Aarthi Bhuvaraghan
- School of Dentistry, University of Leeds, Leeds, UK
- Sree Balaji Dental College and Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Badri Thiruvenkatachari
- Sree Balaji Dental College and Hospital, Bharat Institute of Higher Education and Research, Chennai, India
- University of Manchester, Manchester, UK
| | | |
Collapse
|
9
|
Wilson GJL, Perez-Zabaleta M, Owusu-Agyeman I, Kumar A, Ghosh A, Polya DA, Gooddy DC, Cetecioglu Z, Richards LA. Discovery of sulfonamide resistance genes in deep groundwater below Patna, India. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 356:124205. [PMID: 38797351 DOI: 10.1016/j.envpol.2024.124205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/26/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
Global usage of pharmaceuticals has led to the proliferation of bacteria that are resistant to antimicrobial treatments, creating a substantial public health challenge. Here, we investigate the emergence of sulfonamide resistance genes in groundwater and surface water in Patna, a rapidly developing city in Bihar, India. We report the first quantification of three sulfonamide resistance genes (sulI, sulII and sulIII) in groundwater (12-107 m in depth) in India. The mean relative abundance of gene copies was found to be sulI (2.4 × 10-2 copies/16S rRNA gene) > sulII (5.4 × 10-3 copies/16S rRNA gene) > sulIII (2.4 × 10-3 copies/16S rRNA gene) in groundwater (n = 15) and surface water (n = 3). A comparison between antimicrobial resistance (AMR) genes and wastewater indicators, particularly tryptophan:fulvic-like fluorescence, suggests that wastewater was associated with AMR gene prevalence. Urban drainage channels, containing hospital and domestic wastes, are likely a substantial source of antimicrobial resistance in groundwater and surface water, including the Ganges (Ganga) River. This study is a reference point for decision-makers in the fight against antimicrobial resistance because it quantifies and determines potential sources of AMR genes in Indian groundwater.
Collapse
Affiliation(s)
- George J L Wilson
- Department of Earth and Environmental Sciences and Williamson Research Centre for Molecular Environmental Science, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Mariel Perez-Zabaleta
- Department of Industrial Biotechnology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, AlbaNova University Center, SE-106 91, Stockholm, Sweden
| | - Isaac Owusu-Agyeman
- Department of Industrial Biotechnology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, AlbaNova University Center, SE-106 91, Stockholm, Sweden
| | - Arun Kumar
- Mahavir Cancer Sansthan and Research Center, Phulwarisharif, Patna, 801505, Bihar, India
| | - Ashok Ghosh
- Mahavir Cancer Sansthan and Research Center, Phulwarisharif, Patna, 801505, Bihar, India
| | - David A Polya
- Department of Earth and Environmental Sciences and Williamson Research Centre for Molecular Environmental Science, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Daren C Gooddy
- British Geological Survey, Maclean Building, Wallingford, Oxfordshire, OX10 8BB, United Kingdom
| | - Zeynep Cetecioglu
- Department of Industrial Biotechnology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, AlbaNova University Center, SE-106 91, Stockholm, Sweden
| | - Laura A Richards
- Department of Earth and Environmental Sciences and Williamson Research Centre for Molecular Environmental Science, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, United Kingdom.
| |
Collapse
|
10
|
Rout BP, Dash SK, Otta S, Behera B, Praharaj I, Sahu KK. Colistin resistance in carbapenem non-susceptible Acinetobacter baumanii in a tertiary care hospital in India: clinical characteristics, antibiotic susceptibility and molecular characterization. Mol Biol Rep 2024; 51:357. [PMID: 38400950 DOI: 10.1007/s11033-023-08982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/24/2023] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Acinetobacter baumanii (AB) is a bacterium of concern in the hospital setup due to its ability to thrive in unfavorable conditions and the rapid emergence of antibiotic resistance. Carbapenem resistance in this organism is disheartening, further clouded by the emergence of colistin resistance. AIM The present prospective study aims to note the epidemiology, molecular profile, and clinical outcome of patients with colistin resistance AB infections in a multispecialty tertiary care setup in Odisha, Eastern India. METHODS All AB strains received from March 2021 to February 2022, identified by Vitek2 (Biomerieux) and confirmed by oxa-51 genes, were included. Carbapenem and colistin resistance were identified as per CLSI guidelines. Known mutations for blaOXA-23-like, blaIMP, blaVIM, blaKP, lpxA, lpxC, pmrA, pmrB, and plasmid mediated mcr (mcr1-5) were screened by conventional PCR techniques. The clinical outcome was noted retrospectively from case sheets. Data was entered in MS Excel and tabulated using SPSS software. RESULTS In the study period, 350 AB were obtained, of which 317(90.5%) were carbapenem resistant (CRAB). Among the CRAB isolates, 19 (5.9%) were colistin resistant (ABCoR). The most valuable antibiotics in the study were tigecycline (65.4% in ABCoI; 31.6% in ABCoR) and minocycline (44.3% in CI; 36.8% in CR). There was a significant difference in mortality among ABCoI and ABCoR infections. bla OXA was the predominant carbapenem resistance genotype, while pmrA was the predominant colistin resistant genotype. There were no plasmid mediated mcr genes detected in the present study.
Collapse
Affiliation(s)
- Bidyut Prava Rout
- Department of Microbiology, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Sumesh Kumar Dash
- Department of Microbiology, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Sarita Otta
- Department of Microbiology, IMS & SUM Hospital, Bhubaneswar, Odisha, India.
| | - Birasen Behera
- Department of Microbiology, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Ira Praharaj
- Department of Virology, RMRC (ICMR), Bhubaneswar, Odisha, India
| | - Kundan Kumar Sahu
- Department of Microbiology, IMS & SUM Hospital, Bhubaneswar, Odisha, India.
| |
Collapse
|
11
|
Nandivarmane SB, Manoharan M, Sugumar M, Sistla S. Evaluation of different linezolid susceptibility testing methods and detection of linezolid resistance gene (cfr) in staphylococcal isolates. Indian J Med Microbiol 2024; 47:100516. [PMID: 38000621 DOI: 10.1016/j.ijmmb.2023.100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
Linezolid is an effective oxazolidinone antibiotic against multi resistant Gram-positive organisms. Linezolid resistance is an emerging problem and some controversy exists about the reliability of different phenotypic methods of linezolid susceptibility testing. Fifty isolates each of methicillin resistant S. aureus (MRSA) and Staphylococcus haemolyticus were tested for linezolid susceptibility using Kirby-Bauer disc diffusion, E-test, automated system VITEK2, Broth micro-dilution (reference method) and PCR for the cfr gene. Six resistant isolates were identified, three each in MRSA and S. haemolyticus, all carrying the cfr gene. E-test and VITEK2 were found to be more accurate than disc diffusion test.
Collapse
Affiliation(s)
- Sudarsan Bagavane Nandivarmane
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - Meerabai Manoharan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - Madhan Sugumar
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - Sujatha Sistla
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| |
Collapse
|
12
|
Pattolath A, Adhikari P, Pai V. Carbapenemase-Producing Klebsiella pneumoniae Infections in Diabetic and Nondiabetic Hospitalized Patients. Cureus 2024; 16:e52468. [PMID: 38371145 PMCID: PMC10870097 DOI: 10.7759/cureus.52468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has recently attracted widespread attention due to its limited treatment options and significant morbidity and mortality rates. This study aimed to examine the relationship between risk factors and antimicrobial resistance in individuals with and without diabetes for the development of carbapenemase-producing K. pneumoniae infections. METHODS Between May 2019 and January 2021, a prospective study involving patients with and without diabetes who were infected with K. pneumonia, was carried out in a tertiary care hospital. Six hundred K. pneumoniae isolates were collected from various clinical samples, such as pus/wound samples, urine, respiratory samples, blood, and body fluids. An antimicrobial susceptibility test in K. pneumoniae was performed and compared between diabetics and nondiabetics. Univariate and multivariate logistic regression were used to identify independent risk factors for K. pneumoniae infections in the diabetic group and nondiabetic group separately. Multiplex PCR was used to detect genes that produce carbapenemase. RESULTS A total of 600 patients were infected with K. pneumoniae, with 300 (50%) being diabetic and 300 (50%) being nondiabetic. We found that diabetics had higher antimicrobial resistance to numerous routinely used drugs for infection than the nondiabetic group. In the multivariate analysis of the variables, it was found that immunosuppressive therapy, prior antibiotic use, mechanical ventilation, and urinary catheter use were all significant risk factors influencing the development of K. pneumoniae infections in diabetic patients. Diabetics had a higher prevalence of carbapenemase-producing K. pneumoniae than nondiabetics. Outcome measures in K. pneumoniae patients revealed that the diabetic group had considerably higher infection-related mortality. CONCLUSION We found that CRKP infection was associated with higher resistance to antibiotics in the diabetic group. Furthermore, the diabetic group had a higher prevalence of carbapenemase-producing K. pneumoniae than the nondiabetic group. Crucially, in order to lower mortality without worsening antibiotic resistance and metabolic damage, more focus has to be placed on sensible and efficient antibiotic and supportive care therapies.
Collapse
Affiliation(s)
- Athira Pattolath
- Department of Geriatric Medicine, Yenepoya University Medical College Hospital, Mangalore, IND
| | - Prabha Adhikari
- Department of Geriatric Medicine, Yenepoya University Medical College Hospital, Mangalore, IND
| | - Vidya Pai
- Department of Microbiology, Yenepoya University Medical College Hospital, Mangalore, IND
| |
Collapse
|
13
|
Dorta HG, Nandi A. Patterns of antibiotic use for acute respiratory infections in under-three-year-old children in India: A cross-sectional study. J Glob Health 2023; 13:04159. [PMID: 38131631 PMCID: PMC10740384 DOI: 10.7189/jogh.13.04159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Despite its mostly viral etiology, antibiotics are frequently used to treat acute respiratory infections (ARIs) in children. India is one of the largest global consumers of antibiotics and has one of the highest rates of resistance to antimicrobial treatments. However, the epidemiology of antibiotic treatment among young children in India is poorly understood. Methods Using nationally representative household survey data from the Indian National Family Health Surveys (NFHS) conducted between 2015 and 2016 and 2019 and 2021, we estimated the prevalence of antibiotic use among 17 472 children under the age of three who reported ARI symptoms within two weeks before their mothers were interviewed. To assess the factors associated with antibiotic use for the treatment of ARI symptoms, we used multivariable logistic regression models that included sociodemographic, child-related, household, and health care related characteristics, with results reported on the prevalence difference (PD) scale. Results We estimated that 18.7% (95% CI = 17.8-19.6) of under-three-year-old (U3) children who exhibited ARI symptoms in the two weeks prior to the survey were given antibiotics as a treatment. The highest prevalence was observed in the southern and northern geographic zones of India. Furthermore, multivariable regression models indicated that children with greater access to health services were more likely to receive antibiotics for ARI treatment, regardless of the type of health care facility (public, private or pharmacy/unregulated). Additionally, the prevalence of antibiotic consumption was higher among children from families with religious affiliations other than Muslim and Hindu backgrounds (i.e. Christian, Sikh, Buddhist/neo-Buddhist, Jain, Jewish, Parsi, no religion and other) (PD = 11.7 (95% CI = 6.3-16.7)) compared to Hindu families and among mothers with a secondary or higher education (PD = 5.8 (95% CI = 1.7-9.9)) compared to mothers lacking formal education. Conclusions Our findings provide an important baseline for monitoring the use of antibiotics for the treatment of acute respiratory infections, and for designing interventions to mitigate potential misuse among young children in India.
Collapse
|
14
|
Dhayal VS, Krishnan A, Rehman BU, Singh VP. Understanding Knowledge and Attitude of Farmers towards Antibiotic Use and Antimicrobial Resistance in Jhunjhunu District, Rajasthan India. Antibiotics (Basel) 2023; 12:1718. [PMID: 38136752 PMCID: PMC10740745 DOI: 10.3390/antibiotics12121718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
The misuse of antibiotics in veterinary practices by farmers is harming livestock production and food safety and leading to the rise of antibiotic resistance (AMR). This can also transfer resistant bacteria from animals to humans, posing a serious public health threat. However, we have not paid enough attention to understanding how farmers behave in this regard. Our study aims to explore farmers' behaviors and identify the factors that influence their choices. To conduct this study, we used a questionnaire with 40 questions and surveyed 208 farmers in Jhunjhunu district, Rajasthan. We analyzed the data using SPSS. Here are the key findings: About 58.3% of the farmers have some awareness of antibiotics, and 49.5% are aware of antimicrobial resistance (AMR). Notably, as the level of education increases, so does awareness of antibiotics. Unfortunately, 63.9% of the farmers are not aware of the withdrawal time, and 64% have no idea about the presence of antibiotic residues during this period. Around 75% of farmers vaccinate their animals, but approximately 56.9% of individuals have never undergone an antibiotic sensitivity test (ABST) for milk. Around 48.6% of farmers are unaware of government testing centers. Several factors hinder farmers from implementing proper animal management practices, such as the high fees of veterinarians. When their animals become sick, their first choice is home remedies, followed by using old prescriptions. Additionally, 63.9% stop treatment once the animal looks better. A significant portion (83.8%) of farmers rely on local pharmacists for medicine. It has been determined that there is no significant correlation between education, experience, age, and the level of awareness concerning withdrawal periods, the existence of government antibiotic sensitivity test (ABST) centers, and entities responsible for sending samples for ABST. In our qualitative analysis, focus groups identified significant barriers to following best farm practices and spreading awareness about AMR. These findings suggest that addressing AMR in livestock requires a comprehensive approach. This should include targeted education and awareness programs for farmers, as well as improved access to veterinary services.
Collapse
Affiliation(s)
- Virendra Singh Dhayal
- Department of Biosciences, Shri Jagdishprasad Jhabarmal Tibrewala (JJT) University, Jhunjhunu 333001, India;
| | - Ayana Krishnan
- CSIR-Institute of Genomics & Integrative Biology (CSIR-IGIB), Sukhdev Vihar, New Delhi 110025, India; (A.K.); (B.U.R.)
| | - Bilal Ur Rehman
- CSIR-Institute of Genomics & Integrative Biology (CSIR-IGIB), Sukhdev Vihar, New Delhi 110025, India; (A.K.); (B.U.R.)
| | - Vijay Pal Singh
- CSIR-Institute of Genomics & Integrative Biology (CSIR-IGIB), Sukhdev Vihar, New Delhi 110025, India; (A.K.); (B.U.R.)
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| |
Collapse
|
15
|
Rout B, Dash SK, Sahu KK, Behera B, Praharaj I, Otta S. Evaluation of different methods for in vitro susceptibility testing of colistin in carbapenem resistant Gram-negative bacilli. Access Microbiol 2023; 5:000595.v3. [PMID: 37970087 PMCID: PMC10634484 DOI: 10.1099/acmi.0.000595.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/02/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction The increasing antibiotic resistance like the advent of carbapenem resistant Enterobactarales (CRE), Carbapenem Resistant Acinetobacter baumanii (CRAB), and Carbapenem Resistant Pseudomonas aeruginosa (CRPA) has led to to the use of toxic and older drugs like colistin for these organisms. But worldwide there is an increase in resistance even to colistin mediated both by chromosomes and plasmids. This necessitates accurate detection of resistance. This is impeded by the unavailability of a user-friendly phenotypic methods for use in routine clinical microbiology practice. The present study attempts to evaluate two different methods - colistin broth disc elution and MIC detection by Vitek two in comparison to CLSI approved broth microdilution (BMD) for colistin for Enterobactarales, Pseudomonas aeruginosa , and Acinetobacter baumanii clinical isolates. Methods Colistin susceptibility of 6013 carbapenem resistant isolates was determined by BMD, Colistin Broth Disc Elution (CBDE), and Vitek two methods and was interpreted as per CLSI guidelines. The MIC results of CBDE, Vitek two were compared with that of BMD and essential agreement (EA), categorical agreement (CA), sensitivity, specificity, very major error (VME), major error (ME) and Cohen's kappa (CK) was calculated. The presence of any plasmid-mediated colistin resistance (mcr-1, 2, 3, 4 and 5) was evaluated in all colistin-resistant isolates by conventional polymerase chain reaction. Results Colistin resistance was found in 778 (12.9 %) strains among the carbapenem resistant isolates. Klebsiella pneumoniae had the highest (18.9 %) colistin resistance by the BMD method. MIC of Vitek two had sensitivity ranging from 78.2-84.8% and specificity of >92 %. There were 171 VMEs and 323 MEs by Vitek two method, much more than CLSI acceptable range. The highest percentage of errors was committed for Acinetobacter baumanii (27.8 % of VME and 7.9 % ME). On the other hand, the CBDE method performed well with EA, CA, VME and ME within acceptable range for all the organisms. The sensitivity of the CBDE method compared to gold standard BMD varied from 97.5-98.8 % for different strains with a specificity of more than 97.6 %. None of the isolated colistin resistant organisms harboured mcr plasmids. Conclusion As BMD has many technical complexities, CBDE is the best viable alternative available for countries like India. A sensitive MIC reported by Vitek two needs to be carefully considered due high propensity for VMEs particularly for Klebsiella spp.
Collapse
Affiliation(s)
- Bidyutprava Rout
- Department of Microbiology, IMS and SUM Hospital, SOA University, Kalinga Nagar, Bhubaneswar, India
| | - Sumesh Kumar Dash
- Department of Microbiology, IMS and SUM Hospital, SOA University, Kalinga Nagar, Bhubaneswar, India
| | - Kundan kumar Sahu
- Department of Microbiology, IMS and SUM Hospital, SOA University, Kalinga Nagar, Bhubaneswar, India
| | - Birasen Behera
- Department of Microbiology, IMS and SUM Hospital, SOA University, Kalinga Nagar, Bhubaneswar, India
| | - Ira Praharaj
- Scientist-E, RMRC (ICMR), Bhubaneswar, Odisha, India
| | - Sarita Otta
- Department of Microbiology, IMS and SUM Hospital, SOA University, Kalinga Nagar, Bhubaneswar, India
| |
Collapse
|
16
|
Dudhane RA, Bankar NJ, Shelke YP, Badge AK. The Rise of Non-typhoidal Salmonella Infections in India: Causes, Symptoms, and Prevention. Cureus 2023; 15:e46699. [PMID: 38021876 PMCID: PMC10630329 DOI: 10.7759/cureus.46699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Non-typhoidal Salmonella infections (NTS) are a growing concern in India, posing a significant health risk to the population. These infections are becoming more common at worrisome rates, primarily because of inadequate surveillance. Salmonella non-typhoidal causes severe gastroenteritis and can even cause invasive infections, such as bacteremia, and focal infections, such as meningitis and septic arthritis, and is acquired through contaminated food and water sources. From moderate to severe, the symptoms might vary. Certain serovars exhibit a stronger propensity for specific syndromes, with serious infections more commonly observed in vulnerable populations. Consuming contaminated food, using inadequate sanitation procedures while handling meat from animals slaughtered, and contaminated water supplies are some of the causes of these diseases. Proper food and water treatment, better sanitary facilities, public awareness campaigns, and adherence to food safety laws are all part of prevention measures. The issue of antimicrobial resistance further emphasizes the necessity for prudent antibiotic usage. The Indian government has put in place programs including public awareness campaigns, better sanitary facilities, and stricter food safety laws. In the future, efforts should, however, concentrate on improving laws, boosting hygienic practices, and funding the development of new medicines and vaccines. These actions will lessen the burden of NTS infections in India by assisting in their prevention and management. This review aims to understand the reasons for this growing tendency, which is essential for creating efficient control and prevention strategies.
Collapse
Affiliation(s)
- Radhika A Dudhane
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nandkishor J Bankar
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yogendra P Shelke
- Microbiology, Bhaktshreshtha Kamalakarpant Laxmanrao Walwalkar Rural Medical College, Ratnagiri, IND
| | - Ankit K Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
17
|
Danaei B, Sarmastzadeh T, Khalili F, Yazarlou F, Centis R, D'Ambrosio L, Sotgiu G, Migliori GB, Nasiri MJ. The battle against colistin-resistant E. coli and the need for a one health approach. New Microbes New Infect 2023; 54:101161. [PMID: 37849620 PMCID: PMC10577581 DOI: 10.1016/j.nmni.2023.101161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 10/19/2023] Open
Abstract
Promoting the judicious use of antibiotics is crucial. Physicians and veterinarians must adhere to evidence-based guidelines and prescribe antibiotics only when necessary [26]. Improved diagnostic tools can help identify the most appropriate treatment options.
Collapse
Affiliation(s)
- Bardia Danaei
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tala Sarmastzadeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farima Khalili
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fartous Yazarlou
- Department of Pharmacy, Comenius University Bratislava, Bratislava, Slovakia
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | | | - Giovanni Sotgiu
- Unità di Epidemiologia Clinica e Statistica Medica, Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italy
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
18
|
Prava Rout B, Behera B, Kumar Sahu K, Praharaj I, Otta S. An overview of colistin resistance: A breach in last line defense. Med J Armed Forces India 2023; 79:516-525. [PMID: 37719908 PMCID: PMC10499634 DOI: 10.1016/j.mjafi.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/18/2023] [Indexed: 09/19/2023] Open
Abstract
Rising prevalence of antibiotic resistance and the unavailability of newer drugs to tackle this menace is one of the major hindrances to the goal of health and well-being set up by the General Assembly of the United Nations. The genes responsible for this resistance are often disseminated from hospitals to different environmental sources. In 2015, for the first time, resistance to Colistin was detected caused by chromosomal genetic mutations. Later, plasmid-mediated colistin resistance (MCR-1 to MCR-10) was detected, first from China and then from various other countries. As per Clinical and Laboratory Standards Institute (CLSI), commonly available diffusion techniques cannot detect colistin resistance appropriately. Even commercial susceptibility systems fail in this regard. Keeping in mind the importance of surveillance of colistin-resistant bugs, we present an update on the prevalence, mechanism of resistance, and detection.
Collapse
Affiliation(s)
- Bidyut Prava Rout
- Ph.D. Scholar in Biotechnology, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Birasen Behera
- Ph.D. Scholar in Biotechnology, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Kundan Kumar Sahu
- Professor & Head (Microbiology), IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Ira Praharaj
- Scientist-E, ICMR- RMRC, Bhubaneswar, Odisha, India
| | - Sarita Otta
- Associate Professor (Microbiology), IMS & SUM Hospital, Bhubaneswar, Odisha, India
| |
Collapse
|
19
|
Pattolath A, Adhikari P, Pai V. Clinical and Molecular Profile of Carbapenem Resistant Klebsiella pneumoniae Infections in a Tertiary Care Hospital -Mangalore. Infect Drug Resist 2023; 16:4335-4348. [PMID: 37424665 PMCID: PMC10329450 DOI: 10.2147/idr.s411056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Carbapenemase producing Klebsiella pneumoniae infection has increased in recent years, leading to limitations in treatment options. The present study was undertaken to detect the Carbapenemase-producing genes in K. pneumoniae, the risk factors for acquiring them, and their impact on clinical outcomes. Patients and Methods This prospective study included 786 clinically significant K. pneumoniae isolates. Antimicrobial susceptibility testing was done by conventional method, carbapenem-resistant isolates were screened by carba NP test, and positive isolates were further evaluated by multiplex PCR method. The patient's clinical and demographic details, co morbidity, and mortality were collected. Multivariate analysis was performed to check risk factors for acquiring CRKP infection. Results The results of our study showed high prevalence of CRKP (68%). The variables subjected to the multivariate analysis found that diabetes, hypertension, cardiovascular disease, COPD, use of immunosuppressants, previous hospitalization history, previous surgery, and parenteral nutrition are found to be significantly associated with carbapenem resistant K. pneumoniae infection. Clinical outcomes revealed that patients in the CRKP group had higher risk of mortality and were discharged against medical advice, and they also had higher rate of septic shock. Most of the isolates carried blaNDM-1 and blaOXA-48 carbapenemase genes. Additionally, the co-existence of blaNDM-1 and blaOXA-48 was found in our isolates. Conclusion The prevalence of CRKP was alarmingly high in our hospital with the limited choice of antibiotics. This was associated with high mortality and morbidity with the increase in health care burden. While this information is important to treat critically ill patients with higher antibiotics, strict infection control practices need to be in place to prevent the spread of these infections in the hospital. Clinicians need to be aware of this infection to use appropriate antibiotics to save the lives of critically ill patients with the infection.
Collapse
Affiliation(s)
- Athira Pattolath
- Department of Geriatric Medicine, Yenepoya Medical College Hospital, Yenepoya Deemed to be University, Mangalore, Karnataka, India
| | - Prabha Adhikari
- Department of Geriatric Medicine, Yenepoya Medical College Hospital, Yenepoya Deemed to be University, Mangalore, Karnataka, India
| | - Vidya Pai
- Department of Microbiology, Yenepoya Medical College Hospital, Yenepoya Deemed to be University, Mangalore, Karnataka, India
| |
Collapse
|
20
|
Tilahun M, Gebretsadik D, Seid A, Gedefie A, Belete MA, Tesfaye M, Kebede E, Shibabaw A. Bacteriology of community-acquired pneumonia, antimicrobial susceptibility pattern and associated risk factors among HIV patients, Northeast Ethiopia: cross-sectional study. SAGE Open Med 2023; 11:20503121221145569. [PMID: 36632083 PMCID: PMC9827525 DOI: 10.1177/20503121221145569] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023] Open
Abstract
Objective Pneumonia is an opportunistic infection and it is a major cause of mortality and morbidity among human immunodeficiency virus/acquired immune deficiency syndrome-positive patients. Previous studies have shown the dominant pathogens bacterial isolates were K. pneumoniae 27.0%, S. aureus 20.8%, S. pneumoniae 18.8% and E. coli 8.3%. This study aimed to determine bacteriology of community-acquired pneumonia, antimicrobial susceptibility pattern and associated risk factors among human immunodeficiency virus patients in the Northeast Ethiopia: cross-sectional study. Methods A health facility-based cross-sectional study was conducted from January to April 2021 at six health facilities in Dessie Town. A total of 378 community-acquired pneumonia patients suspected to be human immunodeficiency virus-positive were recruited using a consecutive sampling technique. Sociodemographic and clinical data were collected using a structured questionnaire. A two-milliliter sputum specimen was collected aseptically from each study participant. Samples were cultivated on blood agar, chocolate agar and MacConkey agar to isolate bacterial pathogens. To identify bacteria pathogens Gram stain, colony morphology and biochemical tests were performed. The Kirby-Bauer Disc Diffusion method was used to perform the antimicrobial susceptibility test. Descriptive statistics, logistic regression analysis was carried out using Statistical package for social science version 25 software. p-value < 0.05 with a corresponding 95% confidence interval (CI) was considered for statistical significance. Result The overall prevalence of bacterial pneumonia was 175 (46.3%). Gram-negative bacteria accounted for 119 (68%) and the predominant isolates identified were Streptococcus pneumoniae 49 (28%) followed by Klebsiella pneumoniae 46 (26.3%), Pseudomonas aeruginosa 34 (19.4%). There were 148 (84.6%) multidrug-resistant bacteria overall. Statistically significant factors included viral load, cigarette smoking, cluster of differentiation 4 count, alcohol use, World Health Organization clinical stages III and IV and low white blood cell count. Conclusion The study found that both multidrug resistance and bacterial pneumonia were high. Thus, bacterial culture and antimicrobial susceptibility tests should be routinely performed in health facilities in order to prevent and control the spread of bacterial infection and concurrent drug resistance.
Collapse
Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory
Sciences, College of Medicine and Health Science, Wollo University, Dessie,
Ethiopia,Mihret Tilahun, Department of Medical
Laboratory Science, College of Medicine and Health Sciences, Wollo University,
P.O.BOX: 1145, Dessie 1145, Ethiopia.
| | - Daniel Gebretsadik
- Department of Medical Laboratory
Sciences, College of Medicine and Health Science, Wollo University, Dessie,
Ethiopia
| | - Abdurahaman Seid
- Department of Medical Laboratory
Sciences, College of Medicine and Health Science, Wollo University, Dessie,
Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory
Sciences, College of Medicine and Health Science, Wollo University, Dessie,
Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory
Sciences, College of Medicine and Health Science, Wollo University, Dessie,
Ethiopia
| | - Melkam Tesfaye
- Department of Medical Laboratory
Sciences, College of Medicine and Health Science, Wollo University, Dessie,
Ethiopia
| | - Edosa Kebede
- Department of Medical Laboratory
Sciences, College of Medicine and Health Science, Ambo University, Ambo,
Ethiopia
| | - Agumas Shibabaw
- Department of Medical Laboratory
Sciences, College of Medicine and Health Science, Wollo University, Dessie,
Ethiopia
| |
Collapse
|
21
|
Vijay S, Ramasubramanian V, Bansal N, Ohri VC, Walia K. Hospital-based antimicrobial stewardship, India. Bull World Health Organ 2023; 101:20-27A. [PMID: 36593779 PMCID: PMC9795386 DOI: 10.2471/blt.22.288797] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/26/2022] [Accepted: 10/12/2022] [Indexed: 01/04/2023] Open
Abstract
Objective To establish a framework for implementing antimicrobial stewardship in Indian tertiary care hospitals, and identify challenges and enablers for implementation. Methods Over 2018-2021 the Indian Council of Medical Research followed a systematic approach to establish a framework for implementation of antimicrobial stewardship in Indian hospitals. We selected 20 Indian tertiary care hospitals to study the feasibility of implementing a stewardship programme. Based on a questionnaire to lead physicians before and after the intervention, we assessed progress using a set of process and outcome indicators. In a qualitative survey we identified enablers and barriers to implementation of antimicrobial stewardship. Findings We found an improvement in various antimicrobial stewardship implementation indicators in the hospitals after the intervention. All 20 hospitals conducted monthly point prevalence analysis of cultures compared with three hospitals before the intervention. The number of hospitals that initiated formulary restrictions increased from two to 12 hospitals and the number of hospitals that started practising prescription audit and feedback increased from six to 16 hospitals. Respondents in 15 hospitals expressed their willingness to expand the coverage of antimicrobial stewardship implementation to other wards and intensive care units. Six hospitals were willing to recruit the permanent staff needed for antimicrobial stewardship activities. Conclusion Antimicrobial stewardship can be implemented in Indian tertiary hospitals with reasonable success, subject to institutional support, availability of trained manpower and willingness of hospitals to support antimicrobial stewardship-related educational and training activities.
Collapse
Affiliation(s)
- Sonam Vijay
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, Ansarinagar, 110029India
| | | | - Nitin Bansal
- Division of Infectious Diseases, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - VC Ohri
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, Ansarinagar, 110029India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, Ansarinagar, 110029India
| |
Collapse
|
22
|
Nath H, Khataniar A, Bania KK, Mukerjee N, Al-Hussain SA, Zaki MEA, Rajkhowa S. Nano-functionalization and evaluation of antimicrobial activity of Tinospora cordifolia against the TolB protein of Pseudomonas aeruginosa - An antibacterial and computational study. Front Microbiol 2023; 14:1138106. [PMID: 37113217 PMCID: PMC10126308 DOI: 10.3389/fmicb.2023.1138106] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Antibacterial drug resistance, brought on by the overuse of antibiotics, is one of the biggest threats to human health. It is crucial to consider cutting-edge strategies, such as herbal remedies, to control multidrug-resistant (MDR) bacteria. Methods This study evaluated the phytochemical, antioxidant and antibacterial properties of the various Tinospora cordifolia extracts. Functionalization of the isolated active compound was done using gold (Au) and silver (Ag) nanoparticles (NPs). Further, to understand the interaction of the isolated class, Cordifolisides, with its target, various in-silico methods were used. Results and Discussion The plant was reported from the Charaideo district of Assam, whose methanolic stem extract showed the maximum activity towards the nosocomial pathogen Pseudomonas aeruginosa. Consequently, the active compound was isolated and characterized as belonging to the class Cordifoliside using NMR. The AuNPs and AgNPs functionalized isolates showed enhanced antimicrobial activity against P. aeruginosa compared to the unfunctionalized isolate. The most reactive compound, Cordifoliside C was determined using Density Functional Theory (DFT) analysis, whose interactions with the TolB protein were studied using molecular docking methods, which revealed good binding interactions of Cordifoliside C with the TolB protein. Conclusion This study offers enormous potential for drug design and might be used as a pipeline to address the urgent problem of multidrug-resistance in bacteria. Graphical Abstract.
Collapse
Affiliation(s)
- Himporna Nath
- Centre for Biotechnology and Bioinformatics, Dibrugarh University, Dibrugarh, Assam, India
| | - Ankita Khataniar
- Centre for Biotechnology and Bioinformatics, Dibrugarh University, Dibrugarh, Assam, India
| | - Kusum K. Bania
- Department of Chemical Sciences, Tezpur University, Tezpur, Assam, India
| | - Nobendu Mukerjee
- Department of Microbiology, West Bengal State University, West Bengal, Kolkata, India
- Department of Health Sciences, Novel Global Community Educational Foundation, Hebersham, NSW, Australia
| | - Sami A. Al-Hussain
- Department of Chemistry, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Magdi E. A. Zaki
- Department of Chemistry, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
- *Correspondence: Magdi E. A. Zaki,
| | - Sanchaita Rajkhowa
- Centre for Biotechnology and Bioinformatics, Dibrugarh University, Dibrugarh, Assam, India
- Sanchaita Rajkhowa,
| |
Collapse
|
23
|
Ghosh S, Salhotra R, Singh A, Lyall A, Arora G, Kumar N, Chawla A, Gupta M. New Antibiotic Prescription Pattern in Critically Ill Patients ("Ant-critic"): Prospective Observational Study from an Indian Intensive Care Unit. Indian J Crit Care Med 2022; 26:1275-1284. [PMID: 36755637 PMCID: PMC9886023 DOI: 10.5005/jp-journals-10071-24366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction This study aimed to address the issue of antibiotic prescription processes in an Indian Intensive care unit (ICUs). Materials and methods In a prospective longitudinal study, all adult patients admitted in the ICU for 24 hours or above between 01 June 2020 and 31 July 2021 were screened for any new antibiotic prescription throughout their ICU stay. All new antibiotic prescriptions were assessed for baseline variables at prescription, any modifications during the course, and the outcome of antibiotic prescription. Results A total of 1014 patients fulfilled entry criteria; 59.2 and 7.2% of days they were on a therapeutic and prophylactic antibiotic(s). Patients, who were prescribed therapeutic antibiotic(s), had worse ICU outcomes. A total of 49.5% of patients (502 of 1,014) received a total of 552 new antibiotic prescriptions during their ICU stay. About 92.13% of these prescriptions were empirical and blood or other specimens were sent for culture in 78.81 and 60.04% of instances. A total of 31.7% of episodes were microbiologically proven and were more likely to be prescribed by an ICU consultant. A total of 169 modifications were done in 142 prescription episodes; 73 of them after sensitivity results. Thus, the overall rate of de-escalation was 13.95%. Apart from the negative culture result (36.05%), an important reason for a relatively low rate of de-escalation was the absence of sampling (12.32%). Longer ICU stay before antibiotic prescription, underlying chronic liver disease (CLD), worse organ dysfunction, and septic shock were independently associated with unfavorable treatment outcomes. No such independent association was observed between antibiotic appropriateness and patient outcome. Conclusion Future antibiotic stewardship strategies should address issues of high empirical prescription and poor microbiological sampling hindering the de-escalation process. How to cite this article Ghosh S, Salhotra R, Singh A, Lyall A, Arora G, Kumar N, et al. New Antibiotic Prescription Pattern in Critically Ill Patients ("Ant-critic"): Prospective Observational Study from an Indian Intensive Care Unit. Indian J Crit Care Med 2022;26(12):1275-1284.
Collapse
Affiliation(s)
- Supradip Ghosh
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India,Supradip Ghosh, Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India, Phone: +91 9818590021, e-mail:
| | - Ripenmeet Salhotra
- Department of Critical Care Medicine, Amrita Hospital, Faridabad, Haryana, India
| | - Amandeep Singh
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| | - Aditya Lyall
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| | - Garima Arora
- Department of Critical Care Medicine, Werribee Mercy Hospital, Werribee, Victoria, Australia
| | - Niranjan Kumar
- Department of Critical Care Medicine, Mediversal Multi Superspeciality Hospital, Kankarbagh, Patna, Bihar, India
| | - Aayush Chawla
- Department of Critical Care Medicine, Amrita Hospital, Faridabad, Haryana, India
| | - Meenakshi Gupta
- Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India
| |
Collapse
|
24
|
Katoch O, Sharad N, Singh P, Srivastav S, Aggrawal R, Malhotra R, Mathur P. High Prevalence of Fungal and NDM-OXA Producing Gram-Negative Bacterial Superinfections in the Second Wave of Coronavirus Disease 2019 in India: Experience from a Dedicated Coronavirus Disease 2019 Hospital in North India. J Glob Infect Dis 2022; 14:154-161. [PMID: 36636302 PMCID: PMC9831212 DOI: 10.4103/jgid.jgid_238_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/20/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction During the second wave of coronavirus disease 2019 (COVID-19), superinfection caused by fungus and multidrug-resistant bacteria worsened the severity of illness in COVID-19 patients. Limited studies from India reported the antimicrobial resistance pattern of secondary infections. In this study, we aim to study the epidemiology of pathogens causing superinfections and genotyping of Gram-negative isolates in COVID-19 patients. Methods This retrospective study was conducted at a dedicated COVID-19 center, India. The identification of bacteria/fungi was done by Vitek2® and matrix-assisted laser desorption/ionization-time of flight mass spectrometry system. Identification of beta-lactamase genes was done using thermal cycler. The diagnosis of mucormycosis was based on 10% potassium hydroxide direct microscopy. Statistical analyses were performed using STATA version 15.1 (StataCorp., College Station, TX, USA). For continuous variables, mean and standard deviation were computed. For comparing proportions of secondary infections across admission location and outcomes, the Chi-squared test of independence was used. To compare the mean and median between intensive care units and outcomes, an independent t-test and a Mann-Whitney test were used. Results Of all the clinical samples, 45.4% of samples were cultured positive for secondary infections. Acinetobacter baumannii (35%) was the most common Gram-negative pathogen, while among Gram positive, it was Enterococcus faecium (40%). Among fungus, Candida spp. (61%) predominates followed by molds. Colistin and tigecycline proved effective against these pathogens. blaNDM was the most prevalent gene followed by the blaOX among the carbapenemase genes. Conclusions The mortality rate among COVID-19 patients with secondary infection was significantly higher compared to the overall mortality rate in COVID-19 patients.
Collapse
Affiliation(s)
- Omika Katoch
- Department of Laboratory Medicine, AIIMS, New Delhi, India
| | - Neha Sharad
- Department of Microbiology, AIIMS, New Delhi, India
| | - Parul Singh
- Department of Microbiology, AIIMS, New Delhi, India
| | | | - Richa Aggrawal
- Department of Anesthesia and Critical Care, AIIMS, New Delhi, India
| | | | - Purva Mathur
- Department of Laboratory Medicine, AIIMS, New Delhi, India,Address for correspondence: Prof. Purva Mathur, Department of Microbiology, 3rd Floor, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail:
| |
Collapse
|
25
|
Kumkar SN, Kamble EE, Chavan NS, Dhotre DP, Pardesi KR. Diversity of resistant determinants, virulence factors, and mobile genetic elements in Acinetobacter baumannii from India: A comprehensive in silico genome analysis. Front Cell Infect Microbiol 2022; 12:997897. [PMID: 36519127 PMCID: PMC9742364 DOI: 10.3389/fcimb.2022.997897] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The frequency of infections associated with multidrug resistant A. baumannii has risen substantially in India. The use of next-generation sequencing (NGS) techniques combined with comparative genomics has great potential for tracking, monitoring, and ultimately controlling the spread of this troublesome pathogen. Here, we investigated the whole genome sequences of 47 A. baumannii from India. Methods In brief, A. baumannii genomes were analyzed for the presence of antibiotic resistance genes (ARGs), virulence factors genes (VFGs), and mobile genetic elements (MGEs) using various in silico tools. The AbaR-type resistance islands (AbaRIs) were detected by examining the genetic environment of the chromosomal comM gene. Multilocus sequence types were determined using the Pasteur scheme. The eBURST and whole genome SNPs-based phylogenetic analysis were performed to analyze genetic diversity between A. baumannii genomes. Results and discussion A larger number of A. baumannii isolates belonging to the ST2 genotype was observed. The SNPs-based phylogenetic analysis showed a diversity between compared genomes. The predicted resistome showed the presence of intrinsic and acquired ARGs. The presence of plasmids, insertion sequences, and resistance islands carrying putative ARGs conferring resistance to antibiotics, quaternary ammonium compounds, and heavy metals was predicted in 43 (91%) genomes. The presence of putative VFGs related to adherence, biofilm formation and iron uptake was observed in the study. Overall, the comprehensive genome analysis in this study provides an essential insight into the resistome, virulome and mobilome of A. baumannii isolates from India.
Collapse
Affiliation(s)
- Shital N. Kumkar
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra State, India
| | - Ekta E. Kamble
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra State, India
| | - Nikeeta S. Chavan
- National Centre for Cell Science, Savitribai Phule Pune University Pune, Maharashtra State, India
| | - Dhiraj P. Dhotre
- National Centre for Cell Science, Savitribai Phule Pune University Pune, Maharashtra State, India,*Correspondence: Dhiraj P. Dhotre, ; Karishma R. Pardesi,
| | - Karishma R. Pardesi
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra State, India,*Correspondence: Dhiraj P. Dhotre, ; Karishma R. Pardesi,
| |
Collapse
|
26
|
Mathur P, Malpiedi P, Walia K, Srikantiah P, Gupta S, Lohiya A, Chakrabarti A, Ray P, Biswal M, Taneja N, Rupali P, Balaji V, Rodrigues C, Lakshmi Nag V, Tak V, Venkatesh V, Mukhopadhyay C, Deotale V, Padmaja K, Wattal C, Bhattacharya S, Karuna T, Behera B, Singh S, Nath R, Ray R, Baveja S, Fomda BA, Sulochana Devi K, Das P, Khandelwal N, Verma P, Bhattacharyya P, Gaind R, Kapoor L, Gupta N, Sharma A, VanderEnde D, Siromany V, Laserson K, Guleria R, Malhotra R, Katoch O, Katyal S, Khurana S, Kumar S, Agrawal R, Dev Soni K, Sagar S, Wig N, Garg P, Kapil A, Lodha R, Sahu M, Misra M, Lamba M, Jain S, Paul H, Sarojini Michael J, Kumar Bhatia P, Singh K, Gupta N, Khera D, Himanshu D, Verma S, Gupta P, Kumar M, Pervez Khan M, Gupta S, Kalwaje Eshwara V, Varma M, Attal R, Sudhaharan S, Goel N, Saigal S, Khadanga S, Gupta A, Thirunarayan M, Sethuraman N, Roy U, Jyoti Raj H, D'Souza D, Chandy M, Mukherjee S, Kumar Roy M, Goel G, Tripathy S, Misra S, Dey A, Misra T, Ranjan Das R, Bashir G, Nazir S, Ranjana Devi K, Chaoba Singh L, Bhargava A, Gaikwad U, Vaghela G, Sukharamwala T, Ch. Phukan A, Lyngdoh C, Saksena R, Sharma R, Velayudhan A. Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study. Lancet Glob Health 2022; 10:e1317-e1325. [PMID: 35961355 DOI: 10.1016/s2214-109x(22)00274-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/28/2022] [Accepted: 06/07/2022] [Indexed: 01/04/2023]
|
27
|
Nayak G, Behera B, Mahapatra A, Tripathy S, Biswal J. Molecular Detection of Carbapenemase Enzymes Directly from Positive Blood Cultures Using Xpert Carba-R. J Lab Physicians 2022; 14:365-368. [PMID: 36119431 PMCID: PMC9473928 DOI: 10.1055/s-0042-1744238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The performance of Xpert Carba-R assay for the direct identification of carbapenemases directly from positive blood culture vials was evaluated. Materials and Methods In total, 176 positively flagged blood culture vials, yielding carbapenem-resistant GNB (CR-GNB), were enrolled for the detection and differentiation of blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP using Xpert Carba-R. Results Klebsiella pneumoniae (76/176, 43.1%), Acinetobacter baumannii complex (67/176, 38%), and Escherichia coli (29/176,16.4%) were the predominant isolates. Overall, NDM production was the commonest (61/176, 34.6%), followed by the co-production of NDM + OXA-48 and the absence of any CR gene (44/176, 25%), followed by OXA-48 (27/176, 15.3%). In CR K. pneumoniae , the co-production of NDM + OXA-48 was most frequent (34/76, 44.7%), whereas in the A. baumannii complex , no CR gene was detected in the majority of isolates (38/67, 56.7%). bla NDM was the commonest gene in E. coli (18/29, 62%) and A. baumannii complex (26/67, 38.8%). Conclusion Xpert Carba-R can identify the molecular mechanism of CR within hours after a blood culture turns positive and, thus, has the potential for optimization of antimicrobial therapy, choosing appropriate novel β-lactam combination agents, as well as infection control interventions.
Collapse
Affiliation(s)
- Gayatree Nayak
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Ashoka Mahapatra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Swagata Tripathy
- Department of Anaesthesiology & Critical Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Jyoti Biswal
- Department of Infection Control Nursing, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| |
Collapse
|
28
|
Qadri H, Haseeb Shah A, Mudasir Ahmad S, Alshehri B, Almilaibary A, Ahmad Mir M. Natural products and their semi-synthetic derivatives against antimicrobial-resistant human pathogenic bacteria and fungi. Saudi J Biol Sci 2022; 29:103376. [PMID: 35874656 PMCID: PMC9290337 DOI: 10.1016/j.sjbs.2022.103376] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/09/2022] [Accepted: 07/10/2022] [Indexed: 12/24/2022] Open
Abstract
COVID-19 pandemic has traumatized the entire world. During this outbreak, an upsurge in MDR-associated pathogenic microbial organisms has been recorded. The increasing human microbial diseases pose a severe danger to global human safety. The infectious microbes have developed multiple tolerance strategies to overcome the negative drug impacts. Several naturally occurring chemicals produced from bacteria, plants, animals, marine species, and other sources with antimicrobial characteristics have been reviewed. These compounds show promise in minimizing the globally increasing microbial diseases.
Human infectious diseases caused by various microbial pathogens, in general, impact a large population of individuals every year. These microbial diseases that spread quickly remain to be a big issue in various health-related domains and to withstand the negative drug impacts, the antimicrobial-resistant pathogenic microbial organisms (pathogenic bacteria and pathogenic fungi) have developed a variety of resistance processes against many antimicrobial drug classes. During the COVID-19 outbreak, there seems to be an upsurge in drug and multidrug resistant-associated pathogenic microbial species. The preponderance of existing antimicrobials isn’t completely effective, which limits their application in clinical settings. Several naturally occurring chemicals produced from bacteria, plants, animals, marine species, and other sources are now being studied for antimicrobial characteristics. These natural antimicrobial compounds extracted from different sources have been demonstrated to be effective against a variety of diseases, although plants remain the most abundant source. These compounds have shown promise in reducing the microbial diseases linked to the development of drug tolerance and resistance. This paper offers a detailed review of some of the most vital and promising natural compounds and their derivatives against various human infectious microbial organisms. The inhibitory action of different natural antimicrobial compounds, and their possible mechanism of antimicrobial action against a range of pathogenic fungal and bacterial organisms, is provided. The review will be useful in refining current antimicrobial (antifungal and antibacterial) medicines as well as establishing new treatment strategies to tackle the rising number of human bacterial and fungal-associated infections.
Collapse
Affiliation(s)
- Hafsa Qadri
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar 190006, India
| | - Abdul Haseeb Shah
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar 190006, India
| | | | - Bader Alshehri
- Department of Medical Laboratory Science, College of Applied Medical Sciences, Majmaah University, Majmaah 11952, Saudi Arabia
| | - Abdullah Almilaibary
- Department of Family & Community Medicine, Faculty of Medicine, Albaha University, Alaqiq 307501, Saudi Arabia
| | - Manzoor Ahmad Mir
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar 190006, India
| |
Collapse
|
29
|
Loganathan A, Nachimuthu R. Antibiotic resistance, biofilm forming ability, and clonal profiling of clinical isolates of Staphylococcus aureus from southern and northeastern India. ASIAN BIOMED 2022; 16:191-199. [PMID: 37551171 PMCID: PMC10321179 DOI: 10.2478/abm-2022-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Staphylococcus aureus is a pathogen endemic in India and sometimes deadly for patients in intensive care units. Objectives To determine the antibiotic-resistance pattern, biofilm forming ability, and clonal type of S. aureus from isolates collected in Tamil Nadu (south) and the Mizoram (northeast) regions of India. Methods We collected S. aureus isolates from diagnostic laboratories in Tamil Nadu and Mizoram. An antibiotic susceptibility test was performed according to Clinical Laboratory and Standards Institute methods. Antibiotic-resistant determinants such as mecA, mecC, blaZ, vanA, vanB, and vanC were confirmed by polymerase chain reaction (PCR). All isolates were further studied for biofilm forming ability. Enterobacterial repetitive intergenic consensus (ERIC)-PCR was used for clonal analysis. Results A study of 206 clinical isolates showed 52.9% prevalence of methicillin-resistant S. aureus in Tamil Nadu and 49.4% in Mizoram. Minimum inhibitory concentration tests showed a high prevalence of 67% oxacillin resistance in isolates from Tamil Nadu and 49% in isolates from Mizoram. PCR showed 53% mecA in Tamil Nadu and 49% mecA in Mizoram. Vancomycin-intermediate resistance S. aureus (VISA) prevalence was lower in isolates from Tamil Nadu (4%) and Mizoram (5%). All methicillin-resistant S. aureus (MRSA) isolates formed biofilms. Clonal analysis revealed a genetic relatedness between the isolates. Conclusions The prevalence of MRSA is high in the regions studied, with most of the clinical isolates being multidrug resistant. Adopting appropriate community-based preventive measures and establishing antimicrobial stewardship is highly recommended to minimize the dissemination in antibiotic resistance.
Collapse
Affiliation(s)
- Archana Loganathan
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu632014, India
| | - Ramesh Nachimuthu
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu632014, India
| |
Collapse
|
30
|
Singh A, Bhatia M, Rekha S, Rani D, Kamboj P, Chakraborty D, Gupta P. Comparative Evaluation of Colistin Broth Disk Elution Method With Two Commercially Available Systems for Colistin Susceptibility Testing Against Carbapenem-Resistant Klebsiella pneumoniae: A Single-Center Exploratory Study. Cureus 2022; 14:e25549. [PMID: 35783894 PMCID: PMC9246699 DOI: 10.7759/cureus.25549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose: The purpose is to explore the diagnostic utility of colistin broth disk elution (CBDE) as a simple and reliable method of colistin susceptibility testing. Materials and methods: An exploratory study was undertaken in a tertiary care teaching hospital in Uttarakhand, from September 2021 to March 2022, after obtaining approval from the Institute Ethics Committee. Twenty-five non-repetitive carbapenem-resistant Klebsiella pneumoniae clinical isolates were included in the study. Matrix‐assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) and BD Phoenix M50 system were used to perform species-level identification and antibiotic susceptibility testing (AST), respectively, as per the manufacturer’s instructions. AST results (including those of colistin) were interpreted as per the CLSI guidelines 2022. The test isolates were further subjected to additional in vitro colistin susceptibility testing using a commercially available Mikrolatest colistin susceptibility testing kit and CBDE, respectively. Results: The in vitro colistin resistance rates varied from 8% by BD Phoenix system to 20% by Mikrolatest kit and 32% by CBDE, respectively. For colistin susceptibility, a higher CA was observed between the BD Phoenix system and CBDE (64.71%) than between the Mikrolatest kit and CBDE (31.60%). Overall, a statistically significant fair agreement was observed between the BD Phoenix system and CBDE (Kappa: 0.312; 95% CI: 0.036 to 0.660) and Mikrolatest MIC colistin kit and CBDE (Kappa: 0.286; 95% CI: 0.111 to 0.683), respectively. Conclusions: In vitro colistin testing remains a significant challenge globally. Although the present study results are inconclusive due to the small sample size, we should conduct multi-centric studies globally, taking a considerable sample size representing different Gram-negative bacilli to generate conclusive evidence on the utility of CBDE as a reliable method of colistin susceptibility testing.
Collapse
|
31
|
Sulis G, Pradhan R, Kotwani A, Gandra S. India's ban on antimicrobial fixed-dose combinations: winning the battle, losing the war? J Pharm Policy Pract 2022; 15:33. [PMID: 35484606 PMCID: PMC9047325 DOI: 10.1186/s40545-022-00428-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background and objectives India, the country with the largest market availability of antimicrobial fixed-dose combinations (FDCs), banned certain antimicrobial FDCs in September 2018. Our objective was to examine the impact of Government ban on the sales of antimicrobial FDCs. Methods The sales patterns of 14 of the 26 banned antimicrobial FDCs were analyzed using monthly private sector drug sales data from IQVIA (a comprehensive and nationally representative drug sales database) between January 2018 and December 2019. We carried out descriptive analyses to evaluate the trend in sales over time for banned and non-banned antimicrobial FDCs using cumulative sales volumes. Results Overall, the cumulative sales volume of banned antimicrobial FDCs declined by 75% between January and September 2018 and the same months of 2019, although some banned FDCs continued to be available in significant volumes. The effectiveness of the ban was offset by several pathways. First, the sales of combinations containing moieties belonging to the same drug-classes as the antimicrobials in the banned FDCs increased after the ban. Second, while certain formulations of particular combinations were banned, the sales of other non-banned formulation of these combinations increased. Third, in some cases, products containing new non-antimicrobial components added to the banned combinations remained available. Interpretation and conclusions While sales of the banned antimicrobial FDCs decreased in 2019, we identified several mechanisms that counterbalanced the ban, including implementation failure, rising sales of congeners, and products with additional non-antimicrobial components. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00428-w.
Collapse
Affiliation(s)
- Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Richeek Pradhan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Anita Kotwani
- Department of Pharmacology, V. P. Chest Institute, University of Delhi, Delhi, India
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in Saint Louis, Saint Louis, MO, USA.
| |
Collapse
|
32
|
Evaluation of Colistin Broth Disk Elution and Colistin Agar Test: A study from Tertiary Care Hospital, South India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.2.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Enterobacterales particularly which are resistant to carbapenem group of antibiotics (CRE) are precariously being reported worldwide. Last option for treating the infections caused by CRE are polymyxin E (Colistin) and polymyxin B. Resistance to polymyxins is on higher side because of its increased usage both clinically and non-clinically. In vitro evaluation tests for susceptibility of colistin is associated with lot of complexities due to its innate cationic properties. Hence it is essential for all diagnostic laboratory to standardize colistin testing method, so the present study was undertaken to evaluate the results of colistin broth disk elution (CBDE) and colistin agar test (CAT) in comparison with the reference broth microdilution (rBMD). About 100 CRE clinical isolates were tested, results of CBDE & CAT was compared with rBMD. Categorical agreement (CA) of CBDE was 98% with 2% of very major error (VME), CA of CAT was 99% with 1% of VME in comparison with rBMD. Because of increasing colistin resistance it is crucial to report colistin MIC with a validated method, so we would like to recommend CAT test for routine MIC reporting of colistin since it is feasible test.
Collapse
|
33
|
Al Amin M, Pasha MH, Hoque MN, Siddiki AZ, Saha S, Kamal MM. Methodology for laboratory-based antimicrobial resistance surveillance in animals. Vet World 2022; 15:1066-1079. [PMID: 35698528 PMCID: PMC9178567 DOI: 10.14202/vetworld.2022.1066-1079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/22/2022] [Indexed: 11/20/2022] Open
Abstract
Antimicrobial resistance (AMR) is a crucial and emerging multifactorial “One Health” problem involving human and animal health, agriculture, aquaculture, and environment; and posing a potential public health hazard globally. The containment of AMR justifies effective surveillance programs to explicate the magnitude of the problem across the contributing sectors. Laboratory-based AMR testing and characterization is the key component of an AMR surveillance program. An AMR surveillance program should have a “top management” for fund mobilization, planning, formulating, and multilateral coordinating of the surveillance activities. The top management should identify competent participating laboratories to form a network comprising a reference laboratory and an adequate number of sentinel laboratories. The responsibilities of the reference laboratory include the development of standardized test methods for ensuring quality and homogeneity of surveillance activities, providing training to the laboratory personnel, and in-depth AMR characterization. The sentinel laboratories will take the responsibilities of receiving samples, isolation and identification of microbes, and initial AMR characterization. The sentinel laboratories will use simple antimicrobial susceptibility test (AST) methods such as disk diffusion tests, whereas the reference laboratories should use automated quantitative AST methods as well as advanced molecular methods to explicit AMR emergence mechanisms. Standard guidelines set by Clinical Laboratory Standards Institute or the European Committee on Antimicrobial Susceptibility Testing, should be followed to bring about conformity and harmonization in the AST procedures. AMR surveillance program in animals is eventually similar to that in human health with the exception is that veterinary antibiotics and veterinary pathogens should be given preference here. Hence, the review study was envisaged to look deep into the structure of the AMR surveillance program with significance on laboratory-based AMR testing and characterization methods.
Collapse
Affiliation(s)
- Md. Al Amin
- Quality Control Laboratory, Department of Livestock Services, Savar, Dhaka-1341, Bangladesh
| | | | - M. Nazmul Hoque
- Department of Gynecology, Obstetrics and Reproductive Health, Faculty of Veterinary Medicine and Animal Science, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur-1706, Bangladesh
| | - Amam Zonaed Siddiki
- Department of Pathology and Parasitology, Chittagong Veterinary and Animal Sciences University, Chittagong, Bangladesh
| | - Sukumar Saha
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh-2202, Bangladesh
| | - Md. Mostofa Kamal
- Quality Control Laboratory, Department of Livestock Services, Savar, Dhaka-1341, Bangladesh
| |
Collapse
|
34
|
Seethalakshmi PS, Charity OJ, Giakoumis T, Kiran GS, Sriskandan S, Voulvoulis N, Selvin J. Delineating the impact of COVID-19 on antimicrobial resistance: An Indian perspective. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 818:151702. [PMID: 34798093 PMCID: PMC8592853 DOI: 10.1016/j.scitotenv.2021.151702] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/24/2021] [Accepted: 11/11/2021] [Indexed: 05/23/2023]
Abstract
The COVID-19 pandemic has shattered millions of lives globally and continues to be a challenge to public health due to the emergence of variants of concern. Fear of secondary infections following COVID-19 has led to an escalation in antimicrobial use during the pandemic, while some antimicrobials have been repurposed as treatments for SARS-CoV-2, further driving antimicrobial resistance. India is one of the largest producers and consumers of antimicrobials globally, hence the task of curbing antimicrobial resistance is a huge challenge. Practices like empirical antimicrobial prescription and repurposing of drugs in clinical settings, self-medication and excessive use of antimicrobial hygiene products may have negatively impacted the prevalence of antimicrobial resistance in India. However, the expanded production of antimicrobials and disinfectants during the pandemic in response to increased demand may have had an even greater impact on the threat of antimicrobial resistance through major impacts on the environment. The review provides an outline of the impact COVID-19 can have on antimicrobial resistance in clinical settings and the possible outcomes on the environment. This review calls for the upgrading of existing antimicrobial policies and emphasizes the need for research studies to understand the impact of the pandemic on antimicrobial resistance in India.
Collapse
Affiliation(s)
- P S Seethalakshmi
- Department of Microbiology, Pondicherry University, Puducherry 605014, India.
| | - Oliver J Charity
- NIHR Health Protection Research Unit in Healthcare associated infection and AMR, Department of Infectious Disease, Imperial College London, UK.
| | | | - George Seghal Kiran
- Department of Food Science and Technology, Pondicherry University, Puducherry 605014, India
| | - Shiranee Sriskandan
- NIHR Health Protection Research Unit in Healthcare associated infection and AMR, Department of Infectious Disease, Imperial College London, UK; MRC Centre for Molecular Bacteriology & Infection, Imperial College London, UK.
| | | | - Joseph Selvin
- Department of Microbiology, Pondicherry University, Puducherry 605014, India.
| |
Collapse
|
35
|
Borah P, Dutta R, Das L, Hazarika G, Choudhury M, Deka NK, Malakar D, Hussain MI, Barkalita LM. Prevalence, antimicrobial resistance and virulence genes of Salmonella serovars isolated from humans and animals. Vet Res Commun 2022; 46:799-810. [PMID: 35167002 DOI: 10.1007/s11259-022-09900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
We investigated the prevalence, antimicrobial susceptibility, antimicrobial resistance and virulence genes of Salmonella isolates recovered from humans and different species of animals. Out of 1231 samples, 88 (7.15%) Salmonella isolates were obtained, among which 21 (23.86%) belonged to Salmonella enterica subsp. enterica sero var. Weltevreden, 22 (25%) to S. Enteritidis, 16 (18.2%) to S. Typhi and 14 (15.9%) to S. Newport; 7 (7.95%) isolates were untypable. Among the 88 isolates, 65.90% showed resistance to gentamicin, 61.36% to tetracycline, 61.18% to cefotaxime, 48.86% to trimethoprim, 45.45% to ampicillin, 11.36% to ceftriaxone, 10.22% to chloramphenicol and 7.95% each to ciprofloxacin and cefepime. Most of the isolates were susceptible, with a low MIC (≤ 0.25 μg/ml) value, to cefepime, cefotaxime, ciprofloxacin, ceftriaxone and co-trimoxazole and with a moderate MIC (0.5-4 μg/ml) to ampicillin, tetracycline, gentamicin and chloramphenicol. The resistance genes blaTEM, tetA and dfrA12 were most prevalent, irrespective of the host of origin of the isolates. While invA was used for molecular detection of Salmonella, other virulence genes, viz. sipA, sipB, sipC, stn and pagN, were also detected in all Salmonella isolates. A total of 38.64% isolates were multidrug-resistant (MDR), and various virulence genes were present among the isolated serovars. This study highlights the importance of continuous monitoring and surveillance for pathogenic Salmonella and their potential risks to both humans and animals.
Collapse
Affiliation(s)
- Probodh Borah
- Department of Animal Biotechnology, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati, Assam, 781022, India.,Advanced State Level Biotech Hub, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati, Assam, 781022, India
| | - Rupam Dutta
- Department of Animal Biotechnology, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati, Assam, 781022, India
| | - Leena Das
- Department of Animal Biotechnology, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati, Assam, 781022, India
| | - Girin Hazarika
- Department of Animal Biotechnology, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati, Assam, 781022, India
| | - Mridusmita Choudhury
- Advanced State Level Biotech Hub, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati, Assam, 781022, India
| | - Naba Kumar Deka
- Advanced State Level Biotech Hub, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati, Assam, 781022, India
| | - Dipika Malakar
- Advanced State Level Biotech Hub, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati, Assam, 781022, India
| | - Md Iftikar Hussain
- Department of Animal Biotechnology, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati, Assam, 781022, India
| | - Luit Moni Barkalita
- Department of Animal Biotechnology, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati, Assam, 781022, India
| |
Collapse
|
36
|
Berman D, Chandy SJ, Cansdell O, Moodley K, Veeraraghavan B, Essack SY. Global access to existing and future antimicrobials and diagnostics: antimicrobial subscription and pooled procurement. Lancet Glob Health 2022; 10:e293-e297. [PMID: 34914900 PMCID: PMC8765761 DOI: 10.1016/s2214-109x(21)00463-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/18/2021] [Accepted: 09/24/2021] [Indexed: 02/08/2023]
Abstract
The COVID-19 pandemic has underlined the importance of an efficient and equitable supply of and access to essential health products. These factors are equally pertinent to the antimicrobial resistance pandemic, in which access to a portfolio of existing and pipeline antimicrobials plus complementary diagnostics is crucial. This Viewpoint focuses on market shaping in low-income and middle-income countries (LMICs), where the need for effective antimicrobials and complementary diagnostics is most acute. We propose the creation of a subscription and pooled procurement model that consolidates the growing demand for a portfolio of antimicrobials and diagnostics in LMICs. Anchored by regional market leaders, these pooling mechanisms would guarantee consistent private-sector and public-sector access in participating countries, while creating conditions for long-term best practice in stewardship. Supported by data from South Africa and India, this proposal sets out an innovative approach to tackle the antimicrobial resistance crisis in LMICs.
Collapse
Affiliation(s)
| | - Sujith J Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, India
| | | | - Krishnee Moodley
- Antimicrobial Research Unit, University of KwaZulu-Natal, Durban, South Africa
| | | | - Sabiha Y Essack
- Antimicrobial Research Unit, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
37
|
Bharathi SV, Venkataramaiah M, Rajamohan G. Genotypic and Phenotypic Characterization of Novel Sequence Types of Carbapenem-Resistant Acinetobacter baumannii, With Heterogeneous Resistance Determinants and Targeted Variations in Efflux Operons. Front Microbiol 2022; 12:738371. [PMID: 35002996 PMCID: PMC8735875 DOI: 10.3389/fmicb.2021.738371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/16/2021] [Indexed: 01/21/2023] Open
Abstract
Acinetobacter baumannii has emerged as one of the dominant nosocomial human pathogens associated with high morbidity and mortality globally. Increased incidences of carbapenem-resistant A. baumannii (CRAB) have resulted in an enormous socioeconomic burden on health-care systems. Here, we report the genotypic and phenotypic characterization of novel ST1816 and ST128 variants in A. baumannii strains belonging to International clone II (GC2) with capsule types KL1:OCL8 and KL3:OCL1d from India. Sequence analysis revealed the presence of diverse virulome and resistome in these clinical strains, in addition to islands, prophages, and resistance genes. The oxacillinase bla OXA-23 detected in the genomic island also highlighted the coexistence of bla OXA-66 /bla OXA-98 , bla ADC73 /bla ADC-3 , and bla TEM-1D in their mobile scaffolds, which is alarming. Together with these resistance-determining enzymes, multidrug efflux transporters also harbored substitutions, with increased expression in CRAB strains. The hotspot mutations in colistin resistance-conferring operons, PmrAB, LpxACD, and AdeRS, were additionally confirmed. Phenotype microarray analysis indicated that multidrug-resistant strains A. baumannii DR2 and A. baumannii AB067 preferred a range of antimicrobial compounds as their substrates relative to the other. To our knowledge, this is the first comprehensive report on the characterization of A. baumannii variants ST1816 and ST128, with different genetic makeup and genome organization. The occurrence of CRAB infections worldwide is a severe threat to available limited therapeutic options; hence, continued surveillance to monitor the emergence and dissemination of such novel ST variants in A. baumannii is imperative.
Collapse
Affiliation(s)
- Srinivasan Vijaya Bharathi
- Molecular Biology Division, Council of Scientific and Industrial Research-Institute of Microbial Technology, Chandigarh, India
| | - Manjunath Venkataramaiah
- Molecular Biology Division, Council of Scientific and Industrial Research-Institute of Microbial Technology, Chandigarh, India
| | - Govindan Rajamohan
- Molecular Biology Division, Council of Scientific and Industrial Research-Institute of Microbial Technology, Chandigarh, India
| |
Collapse
|
38
|
Bhat KS, Sanjeevan C. Antimicrobial resistance surveillance among patients with sepsis in intensive care units of a tertiary care center. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2022. [DOI: 10.4103/jcrsm.jcrsm_28_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
39
|
Nair M, Zeegers MP, Varghese GM, Burza S. India's National Action Plan on Antimicrobial Resistance: a critical perspective. J Glob Antimicrob Resist 2021; 27:236-238. [PMID: 34695609 DOI: 10.1016/j.jgar.2021.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022] Open
Abstract
Antimicrobial resistance (AMR) is widely recognised as a global health threat, which is projected to account for more deaths than cancer by 2050. The Government of India has formulated a National Action Plan to tackle AMR (NAP-AMR), largely modelled on the World Health Organization's Global Action Plan on AMR. While the NAP-AMR successfully mirrors the Global Action Plan and lays out ambitious goals, we find that the lack of financial allocation across states, poor enforcement and inadequate multisectoral co-ordination have hampered progress. A broader focus on improving infrastructure for water and sanitation, linking the issue of AMR to existing vertical health programmes for human immunodeficiency virus (HIV) and tuberculosis (TB), prioritising infection prevention and control, strengthening the frontline healthcare workforce in rural and peri-urban settings to reduce reliance on antibiotics, leveraging point-of-care testing and mobile app-based health interventions for diagnosis and surveillance, and adopting a socioecological approach to health and development would help to create an enabling environment for concrete action on AMR in India.
Collapse
Affiliation(s)
- M Nair
- Department of Complex Genetics, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - M P Zeegers
- Department of Complex Genetics, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - S Burza
- Médecins Sans Frontières, New Delhi, India; London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
40
|
Verma R, Pradhan D, Hasan Z, Singh H, Jain AK, Khan LA. A systematic review on distribution and antifungal resistance pattern of Candida species in the Indian population. Med Mycol 2021; 59:1145-1165. [PMID: 34625811 DOI: 10.1093/mmy/myab058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 12/16/2022] Open
Abstract
The emergence of antifungal drug resistance in Candida species has led to increased morbidity and mortality in immunocompromised patients. Understanding species distribution and antifungal drug resistance patterns is an essential step for novel drug development. A systematic review was performed addressing this challenge in India with keywords inclusive of 'Candida', 'Antifungal Drug Resistance', 'Candidemia', 'Candidiasis' and 'India'. A total of 106 studies (January 1978-March 2020) from 20 Indian states were included. Of over 11,429 isolates, Candida albicans was the major species accounting for 37.95% of total isolates followed by C. tropicalis (29.40%), C. glabrata (11.68%) and C. parapsilosis (8.36%). Rates of antifungal resistance were highest in non-albicans Candida (NAC) species - C. haemuloni (47.16%), C. krusei (28.99%), C. lipolytica (28.89%) and C. glabrata (20.69%). Approximately 10.34% isolates of C. albicans were observed to be drug-resistant. Candida species were frequently resistant to certain azoles (ketoconazole-22.2%, miconazole-22.1% and fluconazole-21.8%). In conclusion, the present systematic review illustrates the overall distribution and antifungal resistance pattern of Candida species among the Indian population that could be helpful in the future for the formation of treatment recommendations for the region but also elsewhere.
Collapse
Affiliation(s)
- Rashi Verma
- Department of Biosciences, Jamia Millia Islamia, New Delhi, India.,Biomedical Informatics Centre, ICMR-National Institute of Pathology, New Delhi, India
| | - Dibyabhaba Pradhan
- Indian Council of Medical Research - Computational Genomics Centre, All India Institute of Medical Research, New Delhi, India
| | - Ziaul Hasan
- Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Harpreet Singh
- Indian Council of Medical Research - Computational Genomics Centre, All India Institute of Medical Research, New Delhi, India
| | - Arun Kumar Jain
- Biomedical Informatics Centre, ICMR-National Institute of Pathology, New Delhi, India
| | | |
Collapse
|
41
|
Binsker U, Käsbohrer A, Hammerl JA. Global colistin use: A review of the emergence of resistant Enterobacterales and the impact on their genetic basis. FEMS Microbiol Rev 2021; 46:6382128. [PMID: 34612488 PMCID: PMC8829026 DOI: 10.1093/femsre/fuab049] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/04/2021] [Indexed: 02/06/2023] Open
Abstract
The dramatic global rise of MDR and XDR Enterobacterales in human medicine forced clinicians to the reintroduction of colistin as last-resort drug. Meanwhile, colistin is used in the veterinary medicine since its discovery, leading to a steadily increasing prevalence of resistant isolates in the livestock and meat-based food sector. Consequently, transmission of resistant isolates from animals to humans, acquisition via food and exposure to colistin in the clinic are reasons for the increased prevalence of colistin-resistant Enterobacterales in humans in the last decades. Initially, resistance mechanisms were caused by mutations in chromosomal genes. However, since the discovery in 2015, the focus has shifted exclusively to mobile colistin resistances (mcr). This review will advance the understanding of chromosomal-mediated resistance mechanisms in Enterobacterales. We provide an overview about genes involved in colistin resistance and the current global situation of colistin-resistant Enterobacterales. A comparison of the global colistin use in veterinary and human medicine highlights the effort to reduce colistin sales in veterinary medicine under the One Health approach. In contrast, it uncovers the alarming rise in colistin consumption in human medicine due to the emergence of MDR Enterobacterales, which might be an important driver for the increasing emergence of chromosome-mediated colistin resistance.
Collapse
Affiliation(s)
- Ulrike Binsker
- Department Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Annemarie Käsbohrer
- Department Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany.,Department for Farm Animals and Veterinary Public Health, Institute of Veterinary Public Health, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Jens A Hammerl
- Department Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| |
Collapse
|
42
|
Kar P, Behera B, Mohanty S, Jena J, Mahapatra A. Detection of Colistin Resistance in Carbapenem Resistant Enterobacteriaceae by Reference Broth Microdilution and Comparative Evaluation of Three Other Methods. J Lab Physicians 2021; 13:263-269. [PMID: 34602792 PMCID: PMC8478513 DOI: 10.1055/s-0041-1731137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective
Challenges in susceptibility testing of colistin along with increase in the prevalence of colistin-resistant carbapenemase-producing
Enterobacteriaceae
(CRE) pathogens needs addressal. Evaluation of user-friendly methods is necessary as an alternative to broth microdilution (BMD), the reference susceptibility testing method, for routine implementation in diagnostic clinical microbiology laboratories. Genotypic detection of the plasmid-mediated colistin resistance is also needed for infection control purposes.
Materials and Methods
Colistin susceptibility of 200 nonduplicate clinical CRE isolates from December 2017 to June 2019 was determined by BMD, agar dilution (AD), E test, and rapid polymyxin NP test and interpreted as per the European Committee on Antimicrobial Susceptibility Testing. The results of AD, E test, and NP test were compared with that of BMD, considering minimal inhibitory concentration (MIC) ≤ 2 µg/mL as susceptible and > 2 µg/mL as resistant. Presence of any plasmid-mediated colistin resistance (mcr-1 and 2) was evaluated in 27 colistin-resistant CRE isolates by polymerase chain reaction.
Statistical Analysis
Performance of different phenotypic methods was analyzed by comparing MIC results of AD and E test with that of reference BMD method. Agreement between BMD and the other two methods was expressed in terms of categorical agreement and essential agreement. Errors were expressed as very major error (VME: false-susceptible) and major error (ME: false-resistance) by AD/E test. VME and ME of 3% disagreement were considered unacceptable.
Results
Colistin resistance was found in 27 (13.5%) isolates by BMD method. The VME rates of both AD (11%) and E test (37%) could not meet the Clinical and Laboratory Standards Institute recommendation (< 3% VME rate is acceptable) as alternative tests to the reference BMD. Colistin NP test showed sensitivity and specificity of 85% and 98%, respectively. The percentage discordant result in NP test was highest in
Enterobacter
spp. (17%). None of the 27 colistin resistant isolates showed presence of
mcr-1
and
mcr-2
genes.
Conclusion
High VME rate in AD and E tests precludes their use as alternatives to BMD for colistin susceptibility testing. NP test with moderate sensitivity but excellent specificity can be a good alternative for testing colistin susceptibility in CRE isolates, except in
Enterobacter
spp. Absence of
mcr-1
and
mcr-2
gene necessitates the exploration of other mechanisms of colistin resistance.
Collapse
Affiliation(s)
- Punyatoya Kar
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jayanti Jena
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashoka Mahapatra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| |
Collapse
|
43
|
Genetyping of Carbapenem-resistant Organisms Isolated from Clinical Isolates Received from Tertiary Care Hospitals of Ahmedabad, Gujarat. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.3.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The world is seeing a continuous rise in the levels of antibiotic resistance1. Organisms develop new resistance mechanisms, emerge, and spread the resistance worldwide, making it challenging to treat common infectious diseases. In the current study, clinical isolates received between the years 2017 to 2020 were cultured and the isolated organisms were screened for antibiotic resistance; isolates with multiple drug resistance were further subjected to confirmatory screening through Combined Disc Test (CDT) and Modified Hodge Test (M.H.T.), and molecular characterization to be finally tested for gene expression analysis. Molecular characterization involved screening of genes blaVIM-2, blaKPC-3, blaNDM-1, and blaIMP-11 responsible for imparting carbapenem drug resistance2. From the laboratories of tertiary care hospitals, a total of 1452 clinical isolates were collected and identified. The organisms were subjected to antibiotic susceptibility screening and carbapenem resistance screening. The isolates found positive in the screenings were subjected to molecular characterization for genes, blaVIM-2, blaKPC-3, blaNDM-1, and blaIMP-11, responsible for imparting carbapenem drug resistance. Most of the isolates were resistant variably to aminoglycosides but were found to be resistant to fluoroquinolones and β-lactams group of antibiotics. Carbapenem activity was detected in twelve percent of total isolates and 27 percent among multidrug-resistant isolates. blaNDM-1 gene was found present in 77% isolates, and five organisms among the total number of organisms showed pan drug resistance.
Collapse
|
44
|
Walia K, Gangakhedkar RR. Infectious disease blocks in district hospitals to augment India's resolve to contain antimicrobial resistance. Indian J Med Res 2021; 153:416-420. [PMID: 34380787 PMCID: PMC8354047 DOI: 10.4103/ijmr.ijmr_4031_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kamini Walia
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| | - Raman R Gangakhedkar
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| |
Collapse
|
45
|
Vijay S, Sharma M, Misri J, Shome BR, Veeraraghavan B, Ray P, Ohri VC, Walia K. An integrated surveillance network for antimicrobial resistance, India. Bull World Health Organ 2021; 99:562-571. [PMID: 34354311 PMCID: PMC8319865 DOI: 10.2471/blt.20.284406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess the preparedness of veterinary laboratories in India to participate in an integrated antimicrobial resistance surveillance network and to address gaps in provision identified. METHODS The Indian Council of Medical Research and the Indian Council of Agricultural Research collaborated: (i) to select eight nationally representative veterinary microbiology laboratories whose capacity for participating in an integrated antimicrobial resistance surveillance network would be assessed using a standardized tool; (ii) to identify gaps in provision from the assessment findings; and (iii) to develop a plan, and take the necessary steps to address these gaps in consultation with participating organizations. FINDINGS The main gaps in provision identified were: (i) a lack of dedicated funding for antimicrobial resistance surveillance; (ii) the absence of standard guidelines for antimicrobial susceptibility testing; (iii) a shortage of reference strains for testing and quality assurance; and (iv) the absence of mechanisms for sharing data. We addressed these gaps by creating a veterinary standard operating procedure for antimicrobial susceptibility testing, by carrying out a validation exercise to identify problems with implementing the procedure and by conducting capacity-building workshops for veterinary laboratories. CONCLUSION Antimicrobial resistance surveillance networks depend on the availability of accurate, quality-controlled testing. The challenges identified in creating an integrated surveillance network for India can be overcome by developing a comprehensive plan for improving laboratory capacity in human, veterinary and environmental sectors that is supported by the necessary funds. The study's findings may provide guidance for other low- and middle-income countries planning to develop a similar network.
Collapse
Affiliation(s)
- Sonam Vijay
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Monica Sharma
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Jyoti Misri
- Division of Animal Science, Indian Council of Agricultural Research, New Delhi, India
| | - BR Shome
- Microbial Pathogenesis and Pathogen Diversity Laboratory, Indian Council of Agricultural Research–National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, India
| | | | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - VC Ohri
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| |
Collapse
|
46
|
Chandra P, Mk U, Ke V, Mukhopadhyay C, U DA, M SR, V R. Antimicrobial resistance and the post antibiotic era: better late than never effort. Expert Opin Drug Saf 2021; 20:1375-1390. [PMID: 33999733 DOI: 10.1080/14740338.2021.1928633] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Antimicrobial resistance (AMR) is a multi-layered problem with a calamitous impact on humans, livestock, the environment, and the biosphere. Initiatives and action plan to preclude AMR remain poorly implemented in India.Area covered: This review highlights essential factors contributing to AMR, epidemiology of the resistant bacteria, current treatment options, economic impact, and regulatory efforts initiated by the Indian government to tackle AMR.Expert opinion: Health-care professionals, hospitals, and the general public must understand and cooperatively implement the 'One Health approach,' which entails judicious use of antibiotics in humans, animals, and the environment. Neglecting the AMR problem predicts the expansion of the 'Post-antibiotic era' characterized by drying antibiotic discovery pipelines, overuse of 'Watch' and 'Reserve' groups, coupled with underuse of 'Access' antibiotics, increased daily defined doses, increased healthcare cost, rise in morbidity, mortality, and environmental degradation. The Indian case study elucidates a looming international crisis that demands global attention and commitment for envisaging and implementing locally relevant solutions.
Collapse
Affiliation(s)
- Prashant Chandra
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Unnikrishnan Mk
- Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte University, Deralakatte, Mangaluru, Karnataka, India
| | - Vandana Ke
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dinesh Acharya U
- Department of Computer Science & Engineering, Manipal Institute of Technology Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Surulivel Rajan M
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajesh V
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
47
|
Shah S, Rampal R, Thakkar P, Poojary S, Ladi S. The Prevalence and Antimicrobial Susceptibility Pattern of Gram-Positive Pathogens: Three-Year Study at a Private Tertiary Care Hospital in Mumbai, India. J Lab Physicians 2021; 14:109-114. [PMID: 35982886 PMCID: PMC9381322 DOI: 10.1055/s-0041-1731136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction
The growing resistance pattern of the gram-positive pathogens along with a steady increase in minimum inhibitory concentration of the currently available antibiotics have led to an increase in morbidity and mortality rates in India. This study aims to access the shifting antibiotic susceptibility paradigm of the gram-positive pathogens in various infections at a tertiary care center.
Methods
This is a 3-year retrospective observational study which was performed from January 2016 to December 2018 at a tertiary care hospital in Mumbai. All clinically significant gram-positive cocci isolated from a variety of clinical specimens were studied for their prevalence and antimicrobial susceptibility.
Results
Out of 4,428 gram-positive isolates,
Staphylococcus aureus
(35.3%) was the commonly encountered pathogen, followed by
Enterococcus
spp. (32.1%) and coagulase-negative
Staphylococcus
(CoNS) (25.7%).
S. aureus
was majorly isolated from skin and soft tissue infections (60.3%), followed by patients with respiratory tract infections (18.2%) and blood stream infections (13%). Among
S. aureus
, particularly methicillin-resistant
S. aureus
(MRSA), prevalence increased from 29.5% in 2016 to 35.1% in 2018, with an overall prevalence of 33.6%. All
S. aureus
isolates were 100% sensitive toward vancomycin, linezolid, tigecycline, and teicoplanin. However, the CoNS isolates showed a higher resistance rate with reduced susceptibility toward linezolid and teicoplanin. High prevalence of resistance was observed across gram-positive isolates with commonly used antibiotics such as ciprofloxacin, levofloxacin, and erythromycin. While the prevalence of linezolid-resistant enterococcus (LRE) was 3.6%, vancomycin (VRE) and teicoplanin resistance among the enterococcus species was as high as 7.7% and 7.5%, respectively.
Conclusion
Rising methicillin resistance among the
Staphylococcal
species (MRSA and MR-CoNS) along with reduced susceptibility toward currently available anti-MRSA agents is a matter of serious concern as it limits the therapeutic options for treating multidrug resistant (MDR) gram-positive infections.
Collapse
Affiliation(s)
- Sweta Shah
- Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, Maharashtra, India
| | - Ritika Rampal
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
| | - Pooja Thakkar
- Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, Maharashtra, India
| | - Sushima Poojary
- Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, Maharashtra, India
| | - Shweta Ladi
- Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, Maharashtra, India
| |
Collapse
|
48
|
Manesh A, Varghese GM. Rising antimicrobial resistance: an evolving epidemic in a pandemic. LANCET MICROBE 2021; 2:e419-e420. [PMID: 34230918 PMCID: PMC8248924 DOI: 10.1016/s2666-5247(21)00173-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | | |
Collapse
|
49
|
Microbial Profile and Antibiogram Pattern Analysis of Skin and Soft Tissue Infections at a Tertiary Care Center in South India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.2.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Skin and soft tissue infections (SSTIs) are the most common type of infection globally and also in India. Periodic evaluation of data on microbial profiling and antibiogram trend analysis is mandatory for creating a timely empirical treatment guideline and a proper antimicrobial cycling plan. In the current study, retrospective analysis of the data from 3,570 samples collected from suspected SSTI over one year was performed. Analysis was done on the clinical condition, causative agent/s identified and their antimicrobial susceptibility according to the standard guidelines. Seventy-three percent of samples yielded positive growth, with majority being unimicrobial infections. Gram-negative bacteria (GNB) were more commonly associated with infections from in-patients while Gram-positive cocci (GPC) were seen among out-patients. More than 70% of isolates among GNB were found susceptible to Carbapenems, piperacillin-tazobactam, amikacin and chloramphenicol. Among GPC, maximum sensitivity was seen to glycopeptides, linezolid followed by chloramphenicol, tetracycline, clindamycin and amikacin. Unusual resistance patterns like Penicillin resistant Ampicillin sensitive Enterococcus faecalis (PRASEF)strains, Multidrug resistance (MDR) and Extended drug resistance (XDR) were higher among Enterococci spp, MRSA, Acinetobacter spp and Klebsiella spp. Resistance to penicillin and cephalosporin drugs were high among GNB and GPC. Carbapenems, aminoglycosides, glycopeptides and broad-spectrum antibiotics are found sensitive and potential choices for empirical therapy. As prevalence of MDR and XDR strains were high and the trend analysis shows likelihood of few of the first and second line drugs becoming sensitive in future, we conclude that continued analysis of bacterial profiling and AMR pattern analysis among SSTI is essential.
Collapse
|
50
|
Outcomes and prognostic factors in adolescents and young adults with ALL treated with a modified BFM-90 protocol. Blood Adv 2021; 5:1178-1193. [PMID: 33635331 DOI: 10.1182/bloodadvances.2020003526] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023] Open
Abstract
The use of pediatrics-inspired protocols in adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL) results in superior survival compared with the adult protocols. Pediatrics-inspired protocols carry an increased risk of toxicity and treatment-related mortality in low resource settings, which can offset the potential benefits. We studied the outcomes and prognostic factors in the treatment of AYA ALL with a pediatrics-inspired regimen. We retrieved data regarding demographics, investigations, treatment details, and toxicities from the electronic medical records of patients diagnosed with ALL in the 15- to 25-year-old age group who were initiated on a modified Berlin-Frankfurt-Münster 90 (BFM-90) protocol between January 2013 and December 2016 at the Tata Memorial Centre. A total of 349 patients in the 15- to 25-year-old age group were treated with a modified BFM-90 protocol. The use of this pediatrics-inspired protocol resulted in a 3-year event-free survival (EFS) and overall survival (OS) of 59.4% and 61.8%, respectively. Only 15 patients underwent an allogeneic stem cell transplant. Minimal residual disease (MRD) persistence postinduction emerged as the only factor predictive of poor outcomes. A modified BFM-90 protocol is an effective and safe regimen for AYA ALL with an OS and EFS comparable to the published literature.
Collapse
|