India facing an epidemic of antibiotic resistant superbugs

India facing an epidemic of antibiotic resistant superbugs

Emergence of multidrug-resistant pathogens attacking lungs of patients in critical care is worrying for doctors



At Kasturba Hospital, a 1,000-bed non-profit in the western Indian state of Maharashtra, doctors are battling a rash of antibiotic-resistant "superbug infections."

This happens when bacteria change over time and become resistant to drugs that are supposed to defeat and cure the infection they cause.

According to the Lancet medical journal, such resistance directly caused 1.27 million deaths worldwide in 2019. Antibiotics – which are considered the first line of defense against serious infections – did not work in most of these cases.

• Millions of people are dying from drug-resistant infections

India is one of the countries with what doctors call "antimicrobial resistance" – antibiotic-resistant neonatal infections alone are responsible for about 60,000 newborn deaths each year. A new government report paints a startling picture of how things are getting worse.

Trials conducted at Kasturba Hospital to find out which antibiotic would be most effective in tackling the five main bacterial pathogens found that several key drugs were barely effective.


Acinetobacter baumannii is a multidrug-resistant pathogen

These pathogens include E.coli (Escherichia coli), which are commonly found in the intestines of humans and animals after consumption of contaminated food; Klebsiella pneumoniae, which can cause pneumonia by infecting the lungs, and meningitis by infecting the lining of the blood, skin, and brain; and the deadly Staphylococcus aureus, a food-borne bacteria that can be transmitted through air droplets or aerosols.

Doctors found that some of the main antibiotics were less than 15% effective in treating infections caused by these pathogens. Of most concern was the emergence of a multidrug-resistant pathogen called Acinetobacter baumannii, which attacks the lungs of patients on life support in critical care units.

• Hidden epidemic of antibiotic resistant infections

“Since almost all of our patients cannot afford the high antibiotics, there is a real risk of dying if they develop ventilator-associated pneumonia in the ICU,” says Dr SP Kalantri, medical superintendent of the hospital.

A new report by the Indian Council of Medical Research (ICMR) said that resistance to a potent class of antibiotics called carbapenems - it defeats many pathogens - had increased by 10% in just one year. The report collects data on antibiotic resistance from 30 public and private hospitals every year.

Dr Kamini Walia, a scientist, says, “The reason it is worrying is that it is a great drug to treat sepsis [a life-threatening condition] and sometimes as the first line of treatment in hospitals for very sick patients in ICU It is used." at the Indian Council of Medical Research (ICMR) and lead author of the study.


Broad-spectrum antibiotics comprise 75% of all prescriptions issued in India's hospitals

The ICMR report said that things are so worrying that only 43% of pneumonia infections caused by a pathogen in India can be treated with first-line antibiotics in 2021, up from 65% in 2016.

Saraswati Sinha, a critical care specialist at AMRI Hospital in the eastern city of Kolkata, says the situation is so bad that "six out of 10" patients in her ICU have drug-resistant infections. "The situation is really worrying. We've come to a stage where you don't have a lot of options left to treat some of these patients."

• What would the world be like without antibiotics?

Doctors at Kasturba Hospital say resistance to antibiotics is widespread even among outpatients from villages and small towns with conditions such as pneumonia and urinary tract infections. Since most do not have prescriptions and cannot remember the drugs they were prescribed, doctors find it difficult to obtain a record of their past exposure to antibiotics.

Management of such patients is a difficult ordeal. "The situation is hopeless, And desperate measures - ordering more and more antibiotics is likely to do more harm than good," says Dr. Kalantri.

Public health experts believe that many doctors in India prescribe antibiotics indiscriminately.

For example, antibiotics cannot cure viral diseases such as the flu or the common cold. Patients with dengue -- a viral infection -- and malaria -- caused by a one-celled parasite -- often receive antibiotics. Antibiotics are prescribed for diarrheal diseases and upper respiratory infections, for which they are of limited importance.

During the chaotic treatment of COVID-19, patients were treated with antibiotics resulting in more adverse effects. Last year, an ICMR study of 17,534 Covid-19 patients in Indian hospitals found that more than half of those who acquired drug-resistant infections died.

Yet prescriptions for broad-spectrum antibiotics - drugs that should be reserved to combat the most serious, difficult-to-treat bacterial infections - comprise 75% of all prescriptions issued in India's hospitals, studies have found. .

To be honest, doctors are not to blame entirely. In large, overcrowded public hospitals, Dr Kalantri says, they don't have time to see patients, diagnose their illnesses, sort out bacteria from viral diseases, and plan treatments.

A widespread lack of knowledge about antibiotics means that most patients – rural and urban – are not aware of antibiotic resistance. Even the rich and educated take antibiotics if they fall ill or pressure doctors to prescribe antibiotics.


A study of Covid-19 patients found that more than half of those who acquired drug-resistant infections died

As the prices of antibiotics fall and diagnostics remain expensive, doctors prefer to prescribe drugs rather than order tests. "Doctors sometimes aren't sure what they're treating, and they want to treat everything using broad-spectrum drugs," says Dr. Walia.

Hospital infections are also to blame. Patients are often pumped with antibiotics to compensate for poor hygiene and sanitation, "because no doctor wants to lose a patient to an infection".

Ramanan Lakshminarayana, director of global public health One Health Trust, said, “As far as India goes, it is a perfect storm. There are a lot of infectious diseases in the background, a lack of infection control and a lot of unnecessary consumption of antibiotics. " think tank, say.

Experts agree that India needs to invest more and strengthen diagnostic laboratories, produce more infectious disease physicians, reduce hospital infections and test-based doctors to tackle the growing menace of superbugs. need to be trained on the use of antibiotics. Otherwise, "resistance to antibiotics has the potential to become an epidemic in the near future," warns Dr. Walia.