Epidemiology of antibacterial resistance in Eastern India: An analysis

1. Epidemiology of antibacterial resistance
in Eastern India: An analysis
Dr. Diganta Dey
Dept. of Microbiology
Ashok Laboratory Clinical Testing Centre Pvt. Ltd.

2. Aims and Objective
• Epidemiological studies were carried out in
two phases on samples collected in Kolkata:
– Phase 1: July 2008 – February 2009
– Phase 2: July 2015 – September 2015
• in order to find out the trends of drug
resistance in the community and hospital set-
up.

3. Phase 1: July 2008 – February 2009
This study was conducted on non-duplicate community
specimens to prepare the following statistics:
• Prevalence of ESBL producers among the
Enterobacteriaceae
• Prevalence of MRSA among the S. aureus
• Distribution of ESBL producing bacteria based on patients’
age and gender
• Distribution of MRSA based on patients’ age and gender
• Comparison between fluoroquinolone resistance in ESBL
producer and ESBL non-producer organisms
• Comparison between antibiotic resistance in MRSA and
MSSA

4. Phase 2: July 2015 – September 2015
The following facts and figures were studied in this survey:
• Comparison between the occurrence of significant
bacteriuria and uropathogens in CA and HA UTI
• Prevalence and distribution of ESBL producers associated
with these infections
• Comparative resistance trends between ESBL producer
and non-producer organisms
• Comparative resistance pattern between ESBL producers
originated from CA and HA UTI
• Prevalence of carbapenem resistance within CA and HA
UTI
• Prevalence and antibiotic resistance pattern of Gram
positive organisms in UTI

5. Materials & Methods
• Clean-catch mid-stream urine/ catheterised
urine samples/ Other clinical specimens
• patients of all age groups
• Inoculation- HiChrome UTI agar modified, MA,
E. coli Klebsiella spp. Proteus spp. Staphylococcus

6. • Identification-following standard methods
• Evaluated for antimicrobial susceptibility
profile using Modified Kirby Bauer's disc
diffusion method following CLSI guidelines
• Data statistically analyzed
Disc diffusion ESBL detection

7. Results: Phase 1 study (2008 – 09)
Prevalence of ESBL producers
Percentage of ESBL
producing organism
in (A) Escherichia coli
and
(B) Klebsiella
pneumoniae (n = 200)
Percentage of MRSA obtained by
screening of Staphylococcus
aureus clinical isolates (n = 241)
Prevalence of MRSA

8. Distribution of ESBL producing bacteria among E. coli (138), Klebsiella spp. (49)
and Proteus spp. (13)
Distribution of MRSA (n = 200)

9. Fluoroquinolone resistance and ESBL: a correlation study
(A) Escherichia coli (n = 200) and (B) Klebsiella pneumoniae (n = 200)
MRSA vs. MSSA: antibiotic resistance

10. Results: Phase 2 (2015)
Significant bacteriuria in CA and HA UTI
Isolated uropathogens
E. coli and
Klebsiella spp. are
the forerunners

11. ESBL producing Enterobacteriaceae: prevalence and distribution

12. Carbapenem resistance
Prevalence of
carbapenem
resistance in
(A) CA and (B) HA
uropathogens

13. Distribution of Gram-positive cocci
GPC in (A) CA and (B) HA infections
Staphyloccus vs. Enterococcus: antibiotic resistance
(A) S. aureus
(B) Enterococcus
spp.

14. Enterobacteriaceae vs. non-fermenters: antibiotic
resistance
(A) Enterobacteriaceae and (B) non-fermenter Gram-negative bacilli

15. ESBL producer vs. non-producer: resistance to other antibiotics
Similar resistance
trends were observed
between CA and HA
uropathogens of ESBL
producer / non-
producer.
Comparative resistance
patterns between ESBL
producer and non-
producer organisms

16. Comparison: Phase 1 and Phase 2 study
• Marked increase of ESBL producing
Enterobacteriaceae: ~ 32% in CA UTI and
~41% in HA UTI in ‘phase 2’ study (2015) in
comparison to ‘phase 1’ study (~ 15% of E. coli
and 21% of K. pneumoniae) conducted 5 years
ago (2008 – 09)
• Number of MRSA infections decreased: ~25%
in CA UTI and ~37% in HA UTI in ‘phase 2’
study (2015), and the prevalence was ~52% in
our ‘phase 1’ study (2008 – 09).

17. Comparative statistics of CA and HA UTI
CA UTI HA UTI
Significant bacteriuria 32% 41%
GNB : GPC 91 : 9 80 : 20
Most common GNB E. coli Klebsiella spp.
Most common GPC S. saprophyticus Enterococcus spp.
ESBL producers 31.81% 41.41%
Carbapenem resistance 10% 20%
CRE 9.09% 19.69%
Flouroquinolone resistance (except levofloxacin)
for S. aureus
25% -37% 37% - 42%
Flouroquinolone resistance (except levofloxacin)
for Enterococcus spp.
66%-68% 68%-72%
Levofloxacin resistance for GNB 18% -21% 23%- 27%
Levofloxacin resistance for S. aureus 0% 21%
Levofloxacin resistance for Enterococcus spp. 58% 62%
MRSA 25% 36.84%

18. CONCLUSION
• Alarming rise in AMR, not only in hospital but
also in community acquired UTI - a major
concern
• Lab guided Antimicrobial treatment will
circumvent the menace of uncontrolled and
rapidly spreading drug resistance (MRSA,
ESBL, MBL)

19. ‘Drug resistance follows the drug like a
faithful shadow’
~ Paul Ehrlich