Anti-Microbial Resistance Rises Among Trauma Patients


Ahmedabad : A rising trend of anti-microbial resistance (AMR) has been observed among patients with hospital-acquired infections, mostly ventilator-associated pneumonia, at an Ahmedabad hospital, leading to increased treatment cost and prolonged hospital stay.

The observations emerged after a prospective and observational study of 105 trauma patients over 18 months at Ahmedbad’s NHL Municipal Medical College (NHLMMC).

Dr Supriya Malhotra, head of department of pharmacology at NHLMMC, affiliated to Ahmedabad Municipal Corporation-run SVP Hospital, and a co-author of the study, told The Indian Express that in the past few years, there have been very few antibiotics with novel mechanisms of action to kill the bacteria, adding to the concern around AMR. “The new drug pipeline is almost dry and it might be the end of an era of magic bullets (the antibiotics),” adds Dr Malhotra.

Of the 105 patients studied between December 2019 and December 2020, 36 developed hospital-acquired infections (HAIs) or nosocomial post-traumatic infections (NPIs) with half of them developing multiple infections while the remaining half contracting only a single infection. Of these 36 patients of trauma with infection, 27 patients or 75 per cent had multiple sites of trauma and 10 had multiple organ involvement.

A comparison indicated that patients who developed infections at the hospital had an average of 27 days of hospital stay, while those who who did not develop indications stayed for an average of eight days. The average cost incurred by the patient per day, too, went up by nearly 2.5 times, with those with infections requiring an average of four antibiotics against two antibiotics for those who did not develop infections.

The study calculated that the 69 patients who did not develop infection incurred an average cost of Rs 2,824 per day while those with infections incurred Rs 7,251 per day. The cost was calculated taking into consideration admission charge, cost of antibiotics and laboratory charges.

Following trauma, antibiotics are prescribed initially as a prophylactic line of treatment to prevent trauma-induced infection. However, the authors note that the prolonged stay and extra cost can also be attributed to the age of the patient. The older the patient is, greater are the chances of contracting HAIs due to poor functional and nutritional status.

The study, published in the International Journal of Toxicological and Pharmacological Research in October this year, found that the most common type of NPI in trauma patients was ventilator-associated pneumonia that was seen in 28 patients. Of these, which constituted 78 per cent, nine patients had infection involving multiple organisms, with Acinetobacter baumannii complex being the most common. The organisms were identified through 75 isolates or the infection sample cultured from the 36 patients.

Dr Malhotra says, “Most of the organisms are resistant to conventional antibiotics, so reserve anti-microbials are usually prescribed that are costly and sometimes have side-effects… They might lead to superinfections, which might complicate patients’ condition or prolong their stay.”

Among the 36 who developed infections, 22 had received two antibiotics as prophylactic treatment. The authors noted that given that Colistin was most commonly prescribed for treatment of infection in trauma patients.

The study concludes that “anti-microbial resistance is increasing even as antimicrobial drug development is slowing”. “To reduce the anti-microbial resistance, antibiotic stewardship programmes should be launched in all institutes,” the authors recommend.

Antimicrobial stewardship is defined as “the optimal selection, dosage and duration of anti-microbial treatment that results in the best clinical outcome… with minimal toxicity to the patient and minimal impact on subsequent resistance”. “Prophylactic antibiotic prescription is a double-edged sword. Antibiotics should be prescribed based on microbial identification and timely de-escalation should be done. Broad-spectrum antibiotics (which targets a broad range of organisms) needs to be substituted by narrow spectrum, so that there is less development of AMR. Hospitals should have a strict antibiotic policy,” says Malhotra.

The authors caution that “to reduce the error in prophylactic antibiotics, prescribing repeated regular sensitisation programs for physicians should be conducted in all the institutes and use of antibiotics like Tigecycline, Colistin should be very judicious as they are toxic drugs”.

According to NCRB 2021 data, Gujarat recorded 15,200 road accident cases with 7,457 road accident deaths. Ahmedabad city saw a 21 per cent increase in road accidents in 2021 (1,433) compared to 2020 (1,185). As many as 403 died in road accidents in 2021, while 1,063 were injured in Ahmedabad city. Infections are one of the most common and fatal complications following trauma.


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