Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008-2014

Int J Infect Dis. 2016 Sep:50:75-82. doi: 10.1016/j.ijid.2016.08.002. Epub 2016 Aug 10.

Abstract

Objective: There have been no long-term studies on trends in antibiotic resistance (ABR) on a national scale in India. Using a private laboratory network, the ABR patterns of organisms most commonly associated with bacteremia, obtained from patients across India between 2008 and 2014, were examined.

Methods: A retrospective study of patient blood cultures collected over a 7-year period (January 1, 2008-December 31, 2014) was conducted. Data on the microorganism(s) identified and their antimicrobial susceptibility were obtained from SRL Diagnostics (Mumbai, India).

Results: Of 135268 blood cultures, 18695 (14%) had at least one identified pathogen. In addition to continual high rates of methicillin-resistant Staphylococcus aureus (MRSA; approximately 44.2%), high resistance to nalidixic acid among Salmonella Typhi (98%) was observed, and carbapenem resistance increased in both Escherichia coli (7.8% to 11.5%; p=0.332) and Klebsiella pneumoniae (41.5% to 56.6%; p<0.001). Carbapenem resistance was also stable and high for both Acinetobacter species (approximately 69.6%) and Pseudomonas aeruginosa (approximately 49%). Resistance was also detected to colistin in the Gram-negatives and to vancomycin and linezolid in S. aureus.

Conclusion: Increasing resistance to antibiotics of last-resort, particularly among Gram-negatives, suggests an urgent need for new antibiotics and improved antimicrobial stewardship programs in India.

Keywords: Antibacterial agents; Antibiotic resistance; Blood culture isolates; India; Trends.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / pharmacology*
  • Bacteremia / drug therapy
  • Bacteremia / microbiology*
  • Bacteria / classification
  • Bacteria / drug effects*
  • Bacteria / genetics
  • Bacteria / isolation & purification
  • Blood Culture
  • Carbapenems / pharmacology
  • Drug Resistance, Bacterial*
  • Female
  • Humans
  • India
  • Male
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Microbial Sensitivity Tests
  • Middle Aged
  • Retrospective Studies
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Carbapenems