Bloodstream Infection Cases Are Showing Rising Antibiotic Resistance: Lancet Study

New Delhi: Resistance to last-resort antibiotics used for treating bloodstream infections, a leading cause of deaths and hospitalisations, saw a significant monthly increase from January 2017 to December 2022, a crucial study by researchers has revealed.

The study published in The Lancet this month relied on data not publicly available so far, obtained from 21 tertiary care centres in 14 states that are part of the Antimicrobial Resistance Surveillance Network (IAMRSN) under the Indian Council of Medical Research (ICMR), whose researchers were also involved in the study.

The ICMR data has indicated the spread of superbugs, i.e., pathogens that are resistant to most of the available antibiotics, as well as the rapid increase in other bacteria that neutralise the effects of the drugs, in the country’s population.

As part of the study, ‘Emerging trends in antimicrobial resistance in bloodstream infections: Multicentric longitudinal study in India’, the researchers analysed over 85,000 records of bloodstream infections, which often lead to sepsis, acquired in community and hospital settings. Bloodstream infections significantly impact global health and economics. In 2017, there were about 4.9 crore sepsis cases worldwide, leading to 1.1 crore deaths, 41% of which affected children under five, said the paper. In India, the burden is high particularly, with an estimated annual caseload of 1.1 crore and a mortality rate of 30 lakh.

“Our findings indicate significant monthly increases in Imipenem and Meropenem resistance for Klebsiella, E. coli, and Acinetobacter bloodstream infections,” the researchers associated with the ICMR and Indraprastha Institutes of Information Technology (IIIT), Delhi have noted in the latest study.

Klebsiella, E. coli, and Acinetobacter are common causes of bloodstream infections, while Imipenem and Meropenem belong to a class of strong antibiotics known as Carbapenem, which includes very effective agents most commonly used for the treatment of severe bacterial infections. This class of antibiotics is usually reserved for known or suspected multidrug-resistant (MDR) bacterial infections.

The study also highlighted that Carbapenem resistance in hospital-acquired Klebsiella and Acinetobacter infections preceded that in community-acquired infections.

At the national level, researchers noted, resistance to the Cefotaxime antibiotic used to treat several bacterial infections emerged as a potential early indicator for emerging Carbapenem resistance, proposing a novel surveillance marker.

Antimicrobial resistance (AMR) represents a global health crisis, with an estimated 0.495 crore deaths in 2019 and projections suggesting up to 1 crore annual deaths by 2050, the study has said. Low- and middle-income countries are particularly vulnerable to AMR, a situation exacerbated by high rates of infectious diseases, increased antibiotic use, and the COVID-19 pandemic, the study has added.

The ‘first multicentric point prevalence survey of antibiotic use at 20 national antimicrobial consumption network (NAC-NET) sites India 2021-22’ by the National Centre for Disease Control and released in January this year has already shown that 57 percent antibiotics prescribed in India have potential to cause high AMR.

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