Anindya Das¹* and Diganta Dey²

¹Assistant Professor, Department of Microbiology, KPC Medical College and Hospital, West Bengal University of Health Science, Kolkata, India

*Corresponding Author: Anindya Das, Assistant Professor, Department of Microbiology, KPC Medical College and Hospital, West Bengal University of Health Science, Kolkata, India.

Received: April 25, 2022; Published: May 30, 2022

Abstract

Infectious diseases continue to be a global health problem. In view of this, present work was initiated with an epidemiological assessment of antibiotic resistance pattern in Eastern India. This study was done in two phases; first one in 2009 - 10, and after an interval of about eight years, second one in 2018 - 19. The statistics showed a marked increase of extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae (~ 32% in community acquired urinary tract infections or CA UTI, and ~41% in hospital acquired or HA UTI in our second phase of study (2018 - 19) in comparison to the former study (~ 18%; during 2009 - 10). By and large, these ESBL producing Enterobacteriaceae were found to exhibit greater resistance against several non-β-lactam antibiotics, as compared to ESBL non-producer counterparts. The ‘phase 2’ study also showed an alarming rise in carbapenem resistant Enterobacteriaceae (CRE) cases, with a frequency of ~ 10% in CA and ~ 20% in HA pathogens. Furthermore, an alarming rise in flouroquinolone resistance was noted among the Gram negative, as well as the Gram positive bacteria. However, the number of methicillin resistant S. aureus (MRSA) was found to be comparatively less (~25% in CA UTI and ~37% in HA UTI) during the ‘phase 2’ than in the ‘phase1’ study (~52%). Again, MRSA isolates exhibited significantly (p < 0.05) higher rates of resistance against β-lactam/β-lactamase inhibitor combinations and fluoroquinolones, as compared to the methicillin sensitive (MSSA) isolates. Overall, nosocomial organisms were more resistant against the tested antimicrobials than their community-acquired counterparts. The study demonstrated increasing resistance to most of the commonly used antibiotics, which mandates stringent antibiotic stewardship.

Keywords: Multi-drug Resistant Bacteria (MDR); Extended Spectrum Beta-lactamase Producing Bacteria (ESBL); Nosocomial Infection; Community Acquired Pneumonia; Methicillin Resistant Staphylococcus aureus (MRSA); Methicillin Sensitive Staphylococcus aureus (MSSA)

References

1. Wax RG., et al. “Bacterial Resistance to Antimicrobials”. 2^nd. CRC Press, Taylor and Francis: Boca Raton, FL 33487-2742 (2008).
2. Alanis AD., et al. “Antibacterial properties of some plants used in Mexican traditional medicine for the treatment of gastrointestinal disorders”. Journal of Ethnopharmacology 100 (2005): 153-157.
3. Livermore DM. “Has the era of untreatable infections arrived?” Journal of Antimicrobe and Chemotherapy 64 (2009): i29-36.
4. Livermore DM. “Epidemiology of antibiotic resistance”. Intensive Care Medicine 26 (2000): 14-21.
5. Högberg LD., et al. “The global need for effective antibiotics: challenges and recent advances”. Trends in Pharmacological Sciences 31 (2010): 509-515.
6. Magiorakos AP., et al. “Multidrug-resistant, extensively drug-resistant and pan drug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance”. Clinical Microbiology and Infection 18 (2012): 268-281.
7. Aminov RI. “A brief history of the antibiotic era: lessons learned and challenges for the future”. Frontiers in Microbiology 1 (2010): 134.
8. Davies J and Davies D. “Origins and Evolution of Antibiotic Resistance”. Microbiology and Molecular Biology Reviews 74 (2010): 417-433.
9. Kang C-I and Song J-H. “Antimicrobial resistance in Asia: current epidemiology and clinical implications”. Infectious Chemotherapy 45 (2013): 22-31.
10. Kumarasamy KK., et al. “Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study”. Lancet Infectious Disease 10 (2010): 597-602.
11. Brogden KA., et al. “Human polymicrobial infections”. Lancet 365 (2005): 253-255.
12. Gould IM. “The epidemiology of antibiotic resistance”. International Journal of Antimicrobial Agents 32 (2008): S2-9.
13. Avorn JL., et al. “Antibiotic resistance: synthesis of recommendations by expert policy groups Alliance for the Prudent Use of Antibiotics”. WHO: Geneva Switzerland (2001).
14. Jones CH., et al. “Characterization and sequence analysis of extended-spectrum β-lactamase- encoding genes from Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis isolates collected during tigecycline phase 3 clinical trials”. Antimicrobial Agents and Chemotherapy 53 (2009): 465-475.
15. Mshana SE., et al. “Prevalence of multiresistant Gram-negative organisms in a tertiary hospital in Mwanza, Tanzania”. BMC Research Notes 2 (2009): 49.
16. Abreu AG., et al. “Nosocomial infection and characterization of extended spectrum β-lactamases-producing Enterobacteriaceae in Northeast Brazil”. Revista da Sociedade Brasileira de Medicina Tropical 44 (2011): 441-446.
17. Habeeb MA., et al. “Rapid emergence of ESBL producers in coli causing urinary and wound infections in Pakistan”. Pakistan Journal of Medical Sciences 29 (2013): 540-544.
18. Saima P., et al. “Antimicrobial susceptibility pattern of clinical isolates of methicillin resistant staphylococcus aureus”. Journal of Pakistan Medical Association 2 (2007): 57.
19. Iffat C., et al. “Sensitivity patterns of staphylococcus aureus isolates from services hospital Lahore”. Pakistan Postgraduate Medical Journal 13 (2002): 170-173.
20. Akhter R., et al. “Isolation and antimicrobial susceptibility pattern of methicillin resistant and methicillin sensitive Staphylococcus aureus”. Journal of Surgery Pakistan 14 (2009): 161-165.
21. Aghazadeh M., et al. “Sensitivity pattern of methicillin resistance and methicillin sensitive Staphylococcus aureus isolates, against several antibiotics including trigecycline in Iran. A hospital based study”. Pakistan Journal of Medical Sciences 25 (2003): 443-446.
22. Magilner D., et al. “The prevalence of community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department”. MC Medical Journal 69 (2008): 351-354.
23. Poirel L., et al. “Association of plasmid-mediated quinolone resistance with extended-spectrum β-Lactamase VEB-1”. Antimicrobial Agents and Chemotherapy 49 (2005): 3091-3094.
24. King DE., et al. “New classification and update on the quinolone antibiotics”. American Family Physician 61 (2000): 2741-2748.
25. Ahmed S. “Methicillin resistance among clinical isolates of staphylococcus aureus isolated at a microbiology diagnostic center in Kashmir”. Rawal Medical Journal 34 (2009): 1.
26. Tahnkiwale SS., et al. “Methicillin resistance among isolates of Staphylococcus aureus: antibiotic sensitivity pattern and phase typing”. Indian Journal of Medical Sciences 56 (2002): 330-334.
27. Qureshi AH., et al. “The current susceptibility pattern of methicillin resistant Staphylococcus aureus to conventional anti Staphylococcus antimicrobials at Rawalpindi”. Pakistan Journal of Medical Sciences 20 (2004): 361-364.
28. Garner JS., et al. “CDC definitions for nosocomial infections”. American Journal of Infection Control 16 (1988): 128-140.
29. Zaman R and Dibb WL. “Methicillin resistant Staphylococcus aureus isolated in Saudi Arabia: Epidemiology and antimicrobial resistance patterns”. Journal of Hospital Infection 26 (1994): 297-300.
30. Borer A., et al. “Extended-spectrum beta-lactamase-producing Enterobacteriaceae strains in community-acquired bacteremia in Southern Israel”. Medical Science Monitor 8 (2002): CR44-47.
31. Sturenburg E and Mack D. “Extended-spectrum β-lactamases: Implications for the clinical microbiology laboratory, therapy, and infection control”. Journal of Infection 47 (2003): 273-295.
32. Rodríguez-Baño J., et al. “Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase producing Escherichia coli in nonhospitalized patients”. Journal of Clinical Microbiology 42 (2004): 1089-1094.
33. Valverde A., et al. “Dramatic increase in prevalence of fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae during nonoutbreak situations in Spain”. Journal of Clinical Microbiology 42 (2004): 4769-4775.
34. Pitout JD., et al. “Emergence of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in the community”. Journal of Antimicrobe and Chemotherapy 56 (2005): 52-59.
35. Guembe M., et al. “Evolution of antimicrobial susceptibility patterns of aerobic and facultative gram-negative bacilli causing intra-abdominal infections: results from the SMART studies 2003-2007”. Revista Española de Quimioterapia 21 (2008): 166-173.
36. Jarlier V., et al. “Curbing methicillin- resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program”. Archives of Internal Medicine 170 (2010): 552.
37. Meyer E., et al. “The reduction of nosocomial MRSA infection in Germany: An analysis of data from the hospital infection surveillance system (KISS) between 2007 and 2012”. Deutsches Ärzteblatt International 111 (2014): 331-336.
38. Patel G., et al. “Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies”. Infection Control and Hospital Epidemiology 29 (2008): 1099-1106.
39. Schwaber MJ., et al. “Containment of a countrywide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention”. Clinical Infectious Diseases 52 (2011): 848-855.
40. Chitnis A., et al. “Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions”. Infection Control and Hospital Epidemiology 33 (2012): 984-992.
41. Rhomberg PR and Jones RN. “Summary trends for the Meropenem Yearly Susceptibility Test Information Collection Program: a 10-year experience in the United States (1999-2008)”. Diagnostic Microbiology and Infectious Disease 65 (2009): 414-426.
42. Hidron AI., et al. “NHSN annual update: antimicrobial resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007”. Infection Control and Hospital Epidemiology 29 (2008): 996-1011.
43. Al-Dhaheri AS., et al. “Resistance patterns of bacterial isolates to antimicrobials from 3 hospitals in the United Arab Emirates”. Saudi Medical Journal 30 (2009): 618-623.

Citation

Citation: Anindya Das and Diganta Dey. “Increasing Resistance to Most of the Commonly Used Antibiotics in Eastern India". Acta Scientific Microbiology 5.6 (2022): 91-101.

Copyright

Copyright: © 2022 Anindya Das and Diganta Dey. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.