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- Title
The Mortality Burden of Multidrug-resistant Pathogens in India: A Retrospective, Observational Study.
- Authors
Gandra, Sumanth; Tseng, Katie K; Arora, Anita; Bhowmik, Bhaskar; Robinson, Matthew L; Panigrahi, Bishnu; Laxminarayan, Ramanan; Klein, Eili Y
- Abstract
Background The threat posed by antibiotic resistance is of increasing concern in low- and middle-income countries (LMICs) as their rates of antibiotic use increase. However, an understanding of the burden of resistance is lacking in LMICs, particularly for multidrug-resistant (MDR) pathogens. Methods We conducted a retrospective, 10-hospital study of the relationship between MDR pathogens and mortality in India. Patient-level antimicrobial susceptibility test (AST) results for Enterococcus spp. Escherichia coli , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa , and Enterobacter spp. were analyzed for their association with patient mortality outcomes. Results We analyzed data on 5103 AST results from 10 hospitals. The overall mortality rate of patients was 13.1% (n = 581), and there was a significant relationship between MDR and mortality. Infections with MDR and extensively drug resistant (XDR) E. coli , XDR K. pneumoniae , and MDR A. baumannii were associated with 2–3 times higher mortality. Mortality due to methicillin-resistant S. aureus (MRSA) was significantly higher than susceptible strains when the MRSA isolate was resistant to aminoglycosides. Conclusions This is one of the largest studies undertaken in an LMIC to measure the burden of antibiotic resistance. We found that MDR bacterial infections pose a significant risk to patients. While consistent with prior studies, the variations in drug resistance and associated mortality outcomes by pathogen are different from those observed in high-income countries and provide a baseline for studies in other LMICs. Future research should aim to elucidate the burden of resistance and the differential transmission mechanisms that drive this public health crisis.
- Subjects
INDIA; MORTALITY risk factors; AMINOGLYCOSIDES; ENTEROCOCCUS; ESCHERICHIA coli; GRAM-negative bacteria; KLEBSIELLA; MICROBIAL sensitivity tests; MULTIDRUG resistance; SCIENTIFIC observation; PSEUDOMONAS; STAPHYLOCOCCUS aureus; RETROSPECTIVE studies; METHICILLIN-resistant staphylococcus aureus; MIDDLE-income countries; LOW-income countries; GRAM-negative aerobic bacteria
- Publication
Clinical Infectious Diseases, 2019, Vol 69, Issue 4, p563
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy955