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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 24-29

Prevalence of antimicrobial-resistant infection among patients attending Assam Medical College and Hospital, Dibrugarh


1 Department of Community Medicine, Assam Medical College & Hospital, Dibrugarh, Assam, India
2 Department of Epidemiology and Nutrition, ICMR-Regional Medical Research Centre, N.E. Region, Dibrugarh, India
3 Department of Microbiology, Assam Medical College & Hospital, Dibrugarh, Assam, India

Date of Submission23-Jul-2021
Date of Acceptance27-Jul-2021
Date of Web Publication05-Oct-2021

Correspondence Address:
Dr. Gourangie Gogoi
Department of Community Medicine, Assam Medical College and Hospital, Dibrugarh 786002, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajoim.ajoim_7_21

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  Abstract 

Background: The burden of antimicrobial resistance (AMR) is increasing globally at an alarming rate, especially among hospitalized cases. However, there is still lack of knowledge about morbidity and mortality due to AMR infections among different populations. The present study was aimed to provide a brief insight on the prevalence of AMR infection among the patients attending Assam Medical College and Hospital, Dibrugarh, Assam, India. Materials and Methods: A retrospective cross-sectional study was conducted among the patients admitted in the hospital from April 2018 to April 2019. Blood culture reports of AMR-positive cases were collected from the Microbiology Department and hospitalization records including clinical and demographic data were retrieved from the Medical Records Department. Results: Overall, 251 blood culture reports positive for AMR infection were obtained during the study period. Of this, 96 cases (38.25%, 96/251) were females and 155 (61.75%, 155/251) were males. AMR infection was mostly prevalent among younger age group (0–1 month) with 85.65% (215/251). Methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumonia were the most frequently identified AMR pathogens in the study population with 31.47% (79/251), 23.90% (60/251), and 17.93% (45/251), respectively. Conclusion: The identified AMR pathogens were mostly prevalent among young infants and characterized with multidrug resistance. However, the extended study in increased population mostly among hospitalized cases may provide insights for understanding the burden of AMR and associated risk factors.

Keywords: Antimicrobial resistance, cross-sectional study, infants, multidrug resistance, prevalence


How to cite this article:
Gogoi G, Dutta M, Choudhury G. Prevalence of antimicrobial-resistant infection among patients attending Assam Medical College and Hospital, Dibrugarh. Assam J Intern Med 2021;11:24-9

How to cite this URL:
Gogoi G, Dutta M, Choudhury G. Prevalence of antimicrobial-resistant infection among patients attending Assam Medical College and Hospital, Dibrugarh. Assam J Intern Med [serial online] 2021 [cited 2021 Oct 18];11:24-9. Available from: http://www.ajimedicine.com/text.asp?2021/11/2/24/327548


  Introduction Top


Antimicrobial resistance (AMR) represents a serious threat to human health over the last few decades, with simultaneous increase in resistance among common bacterial pathogens globally.[1],[2],[3],[4],[5],[6] Despite many scientific initiatives for public awareness, there is a continuous trend of increasing antibiotic resistance around the world.[7] The mortality rate is high among cases infected by antibiotic resistance bacteria and results in longer duration of hospital stays, increased medical expenses,[8] and ultimately leads to increased socioeconomic burden according to the World Health Organization (WHO) fact sheet.[9] More than 50% of hospital-acquired infections are caused by antibiotic resistance pathogens.[10] However, the resistance to these infections is more critical among the intensive care unit (ICU) patients.[11],[12]

Multidrug resistance (MDR) serves as a major challenge to public health around the world for treating bacterial infections.[13] It is estimated that around 700,000 deaths are caused by MDR bacteria annually, and higher mortality rate and severe economic loss are expected in the near future.[14] Many studies have been targeting on MDR pathogens such as vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus (MRSA) for their increasing resistance.[15],[16] However, other pathogens which are at increasing trend of resistance are Klebsiella species, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter species, and  Escherichia More Details coli.[17],[18],[19]

Regardless of public health threat to increasing antibiotic resistance, there is paucity of information related to the impact of antibiotic resistance in health and economic status of population.[20],[21] It is assumed that increasing antibiotic-resistant infection cases are due to excessive use of antibiotics along with its use without treatment indications. A recent study indicated that India was the highest among the consumption of antibiotics during 2000–2010, followed by China and the USA.[22] In most Indian health facilities, there is lack of quality screening and reporting of MDR pathogens.[7] Further, it is observed that healthcare facilities with general wards that consist of multi-bed facility increase the chance of AMR transmission among the hospitalized cases.[23] Notably, it has become important for hospital-based AMR surveillance which can typically focus on AMR pathogens and its resistance to multiple drugs that are of great clinical importance. With this, the present study aimed to determine the prevalence of AMR pathogens among the patients attending Assam Medical College and Hospital, Dibrugarh, which may provide an insight for reducing the burden of AMR transmission.

Ethics approval

The study was approved by the Ethics Committee (human) of Assam Medical College and Hospital, Dibrugarh, Assam. Ethics approval was obtained to utilize pseudo-anonymized data from Microbiology and Medical Records Department with internal information administration procedures. As the data were collected and analyzed pseudo-anonymously, patient consent could not be obtained.


  Materials and Methods Top


Study design

A cross-sectional study design was used to form a database for the present research using secondary data collected from April 2018 to April 2019. A retrospective data analysis was performed for all the positive blood culture reports (secondary data) of AMR infection cases, retrieved from Microbiology and Medical Records Department (MRD).

Study site

The study was conducted at Assam Medical College and Hospital, situated in Dibrugarh district of Assam, Northeast India. Patients with positive blood culture reports and AMR infections, attending Assam Medical College and Hospital, were recruited for the present study.

Data collection

Blood culture reports of AMR-positive cases that included all age groups were collected from the Microbiology Department of Assam Medical College and Hospital, from April 2018 to April 2019. Clinical data, demographic data, and hospitalization records of all the included patients with positive blood culture reports were collected from the Medical Records Department. The patient records were considered eligible if they met the inclusion criteria: patients who had infection with AMR pathogens from April 2018 to April 2019 and all other related information of the included patients were available in medical records.

Statistical analysis

The collected data of the study population were analyzed using IBM SPSS Statistics 26.0 (IBM, New York, NY, USA). The results of the analyzed data were processed using Microsoft Excel 2007.


  Results Top


A total of 251 positive blood culture reports for AMR infection were obtained between April 2018 and April 2019 from Assam Medical College and Hospital, Dibrugarh, Assam. Out of the 251 blood culture-positive cases, 96 cases (38.25%, 96/251) were females and 155 (61.75%, 155/251) were males. AMR-positive cases were mostly prevalent among younger age group (0–1 month) with 85.65% (215/251). The mean age was 11.88±8.02 days. [Table 1] represents the age-wise distribution of AMR-positive cases of Assam Medical College and Hospital during the study period. During the study period, most of the AMR-positive cases were detected in the month of October, December, and March with 37, 31, and 30 blood culture-positive cases, respectively. [Figure 1] depicts the month-wise distribution of AMR-positive cases of Assam Medical College and Hospital from April 2018 to April 2019.
Table 1: Age-wise distribution of AMR cases of Assam Medical College and Hospital from April 2018 to April 2019

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Figure 1: Month-wise distribution of AMR-positive cases of Assam Medical College and Hospital from April 2018 to April 2019

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Most of the AMR-positive cases identified among early age group were characterized with respiratory infection and sepsis. Other clinical diagnoses of the AMR-positive cases were tissue infection, urinary tract infection, and gastrointestinal infection. The most common AMR pathogens identified in blood culture of the patients were MRSA, A. baumannii, and K. pneumonia in 31.47% (79/251), 23.90% (60/251), and 17.93% (45/251) AMR-positive cases, respectively. [Figure 2] represents the distribution of blood culture-positive cases with multiple antimicrobial resistant pathogens during the study period.
Figure 2: Distribution of blood culture-positive cases with multiple AMR pathogens from April 2018 to April 2019

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The antibiotic susceptibility of AMR pathogens identified in blood cultures showed a wide antibiotic sensitivity pattern [Table 2]. About 31.87% (80/251) AMR-positive cases identified with S. aureus were resistant to methicillin. Blood cultures of AMR-positive cases, identified with A. baumannii, were mostly susceptible to carbepenem antibiotics that include meropenem (14.74%, 37/251) and imipenem (11.16%, 28/251), followed by 4.78% (12/251) resistant to ertapenem. K. pneumonia identified in most of the AMR-positive cases was susceptible to carbepenem and cephalosporin antibiotics that comprises of imipenem, meropenem, ertapenem, and cefuroxime.
Table 2: Distribution of AMR-positive cases infected with multiple antibiotic resistance pathogens in Assam Medical College and Hospital from April 2018 to April 2019

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  Discussion Top


Antibiotic resistance is increasing at an alarming rate that threatens public health globally.[24] According to the World Health Organization (WHO), AMR ranks in the top 10 public health threat globally.[25] However, it is believed that the main cause for the growth of drug-resistant pathogens is misuse and overuse of antimicrobials.[25] Over the past decades, the AMR pathogens adapted to MDR pathogens, predominantly S. aureus and Enterococcus species, among all age groups of population and significantly associated with morbidity and mortality.[26] The present study provides a brief overview of AMR infection and circulating AMR pathogens among the native population of Assam, Northeast India.

AMR infection was mostly prevalent among younger age group in the present study. Another recent study also noted a higher prevalence of AMR infections among young infants and neonates.[27] A striking feature for higher prevalence of antibiotic resistance among young infants is the frequent usage of antibiotics in the first 6 months after birth, as studied earlier.[28] Subsequently, higher antibiotic use during the early stage is characterized with increased episodes of respiratory illnesses and diarrhea.[29] Additionally, according to the WHO, the recurrent usage of antibiotics for treating bacterial infections predominantly urinary tract infections, diarrhea, and sepsis increases the resistance of AMR pathogens at an alarming rate globally.[25] Likewise, the present study provides related data on the association of age and prevalence of antibiotic resistance similar to earlier studies.

In the present study, MRSA was found to be the highly prevalent AMR pathogen among the study population. Many studies also revealed that S. aureus is the main source of bloodstream infections in the early stages of life[30],[31],[32] and is the most common hospital-acquired infection.[33] However, a review study has found MRSA to be non-susceptible to many antibiotics including gentamicin, erythromycin, and clindamycin, followed by high sensitivity to vancomycin.[34]

Another common AMR pathogen among our study population was A. baumannii. It is known that A. baumannii is associated with many infections among populations, and carbapenem-resistant A. baumannii is of great concern globally. The prevalence of A. baumannii in children was found to be 13.2-32.5% in a recent study.[35] However, our study observed a prevalence of 23.90% in the study population.

K. pneumonia, a common gut bacterium, causes a life-threatening infection among hospitalized children.[25],[36] About 27% of children were infected with K. pneumonia in a study population.[36] Another study found that MDR K. pneumonia infection is a major cause for developing sepsis among pediatrics and characterized with longer hospital stay and prolonged ventilation requirement. However, the use of third-generation cephalosporin and carbepenems are independently associated risk factors for the development of sepsis during K. pneumonia infection.[37] In our study population, about 17.93% of AMR-positive cases were identified with K. pneumonia infection, which predominantly includes young infants below 1 month.

In conclusion, the present study provided a brief description about the resistance of identified AMR pathogens among the study population in Assam Medical College and Hospital, which has not been studied earlier. The MDR AMR pathogens were predominantly prevalent among younger age group characterized with respiratory illness. Further study in extended population size may emphasize on reducing the burden of antibiotic resistance and associated risk factors among different populations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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