Rise In AMR Is Leaving Doctors With Fewer Options In Drugs

Ahmedabad: Imagine a bacterial infection with no known cure — a relentless adversary that defies conventional treatments and leads to prolonged illness and hospitalization. This was the condition of nine people admitted to Civil Hospital. Their battle against microbial infections from Nov 2023 to Feb 2024 took a harrowing turn when the culprit was identified as Colistin-resistant bacteria. Despite medical interventions and hospital stays, their prospects for recovery grew increasingly dim in the face of this formidable foe.

Colistin is a polymyxin antibiotic used to treat bacterial infections caused by susceptible gram-negative bacteria (organisms resistant to multiple drugs and increasingly resistant to most antibiotics).

The data on Colistin-resistant bacterial infections was revealed in a study titled ‘Study for detection of Colistin resistance among multi-drug resistant gram-negative bacterial isolates from different chemical samples at tertiary care hospital’ presented during the two-day GAMMACON 2024 conference that concluded in the city on Sunday. The research was conducted by Dr Niti Gor, Dr Manisha Patankar, Dr Neeta Khandelwal and Dr Sumeeta Soni from the microbiology department at BJ Medical College (BJMC).

“Colistin is considered the last resort for the patients with acute and chronic infections caused by gram-negative bacteria. It has toxicity and is administered after much consideration. If the bacteria from such persons is Colistin-resistant, it leaves clinicians with no remedy,” said Dr Soni, associate professor of microbiology at BJMC and one of the researchers.

Out of the nine infections, eight were Klebsiella pneumoniae and one was Pseudomonas aeruginosa.

The study, based on over 20,000 samples from Civil Hospital — the biggest government-run tertiary care hospital in Gujarat — highlighted a concerning trend: out of 5,000 gram-negative bacteria identified over four months, 26 displayed Colistin resistance. Further tests by the broth microdilution (BMD) method gave nine confirmed samples which were also certified by national labs. “About five years ago, we would get just one or two such cases,” said Dr Soni.

Civil Hospital is the biggest government-run tertiary care hospital in Gujarat and the data by the team was based on the analysis of 20,000-odd samples. Out of the total, 5,000-odd samples were found to have gram-negative bacteria which has higher prevalence of antimicrobial resistance (AMR) in the Indian context. The researchers pointed out that out of 5,000, about 1,200 were multi-drug resistant (MDR) which accounted for 23% of the total samples.

Dr Bhavin Kapadiya, organizing chairman of GAMMACON, said that the rampant use of antibiotics during Covid and indiscriminate use of antibiotics for anything from cold to pain, has led to the rise in AMR.

Dr Urvesh Shah, professor and head of the microbiology department at GCS Hospital, said that the annual report of Indian Council of Medical Research (ICMR) for AMR in 2021 had indicated a gradual rise of antimicrobial resistance (AMR) and multi-drug resistance (MDR) in the Indian context. “For example, susceptibility of Imipenem class of antibiotics used to treat severe infections reduced from 65% in 2016 to 43% in 2021 for Klebsiella, and from 85% in 2016 to 64% in 2021 for E coli,” he said, adding: “The rise in AMR is leaving doctors with fewer options in drugs and new research is not happening fast enough to match the rise.”

Researchers from BJMC said empirical use of Colistin should be prevented to decrease resistance in gram-negative isolates. Colistin resistance in MDR organisms is a serious threat and there is a need for awareness among clinicians about the judicious use of antibiotics and strict infection control practices, they added.

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