AI Article Synopsis
- A study analyzed antimicrobial resistance (AMR) in six WHO priority pathogens across twelve Indian states from 2011 to 2022 to identify surveillance gaps and help shape health policies.
- Out of 55 included studies, E. coli was the most commonly isolated pathogen, followed by S. aureus and Enterococcus, with significant resistance rates observed for ESBL and carbapenem.
- The findings revealed a concerning high prevalence of resistance to first-line antibiotics and highlighted the need for improved monitoring and interventions in addressing AMR in the region.
Article Abstract
Background: Determining regional patterns of antimicrobial resistance in bacterial infections in the healthcare setting (AMR) identifies surveillance gaps and informs policies for mitigation. We estimated the prevalence of AMR for six WHO priority pathogens in diagnostic and surveillance samples in the twelve east and north-east Indian states from 2011 to 2022 (PROSPERO ID: CRD42021278961).
Methods: Studies were searched on Medline, Scopus, and Web of Science. Observational, descriptive, and cross-sectional studies, reporting AMR based on laboratory diagnostics, in individuals from east and north-east India from 2011 to 2022 were included. Four reviewers in pairs conducted abstract, full-text screening, and data extraction. We estimated the prevalence of resistance in fifty-four pathogen-antibiotic combinations, and six antibiotic resistance patterns. Pooled estimates of prevalence (Ɵ), heterogeneity (I), and 95 % confidence intervals were calculated using the random effects model.
Results: Fifty-five studies were included. Information was available for nine states, none from Arunachal Pradesh, Mizoram, and Nagaland. E. coli was most frequently isolated (59.2 %, 95 % CI: 48.8-69.6 %), followed by S. aureus (36.2 %, 95 % CI: 20.2-52.2 %), Enterococcus (27.5 %, 95 % CI: 11.2-43.7 %), Klebsiella (25 %, 95 % CI: 15-35 %), Acinetobacter (15.7 %, 95 % CI: 2.3-29.1 %), and Pseudomonas aeruginosa (15.7 %, 95 % CI: 4.1-27.3 %). There was high prevalence of ESBL (45 %, 95 % CI: 35-55 %) and carbapenem resistance (30 %, 95 % CI: 22-38 %). AmpC (23 %, 95 % CI: 9-37 %) and colistin resistance was lower (10 %, 95 % CI: 0-22 %) but supporting data was limited. Overall prevalence of MRSA was 26 % (95 % CI: 14-39 %), and VRE was 9 % (95 % CI: 0-17 %).
Conclusion: High prevalence of resistance was seen to all first-line antibiotics. Gram positive bacteria had high resistance to penicillins, and Gram negatives to third-generation cephalosporins, beta-lactam/beta-lactamase inhibitors, and carbapenems. Aminoglycoside, fluoroquinolone, and trimethoprim-sulphamethoxazole resistance was common across all genera. Critical regional AMR information gaps exist.
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| http://dx.doi.org/10.1016/j.ijmmb.2024.100732 | DOI Listing |
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