Antimicrobial resistance (AMR) at the community level

Abstract

Context: The emergence of antimicrobial resistance (AMR) is a major public health crisis in India and globally. While national guidelines exist, the sources of data which form the basis of these guidelines are limited to a few well-established tertiary care centres. There is inadequate literature on AMR and antibiotic mismatch from India at community level and even less literature on AMR patterns from rural India. Aims: The aims of this study were as follows: 1) to describe the patterns of AMR at an urban tertiary care hospital and a rural 100 bedded hospital; 2) to compare and contrast the AMR patterns noted with published ICMR guidelines; 3) to examine the issue of AMR and antibiotic mismatch; and 4) to identify local factors influencing drug-bug mismatch at the local level. Settings and Design: The data were obtained from two independently conceived projects (Site 1: Urban tertiary care hospital, Site 2: Rural 100-bedded hospital). Methods and Materials: Local antibiograms were made, and the antibiotic resistance patterns were compared between the urban and rural sites and with data published in the 2017 ICMR national guideline for AMR. Statistical Analysis Used: Descriptive statistics including means and medians were used. Results: Our data reveal: a) a significant mismatch between sensitivity patterns and antibiotics prescribed; b) The national guidelines fail to capture the local picture of AMR, highlighting the need for local data; and c) challenges with data collection/retrieval, access and accuracy of diagnostic tools, administrative issues, and lack of local expertise limit antimicrobial stewardship efforts. Conclusions: Our study finds the burden of AMR high in both rural and urban sites, reinforcing that AMR burden cannot be ignored in rural settings. It also highlights that national data obtained from tertiary care settings fail to capture the local picture, highlighting the need for local data. Mechanisms of linking rural practices, primary health centres, and small hospitals with a common microbiology laboratory and shared data platforms will facilitate antibiotic stewardship at the community level.

Antibiotic resistance through the lens of One Health: A study from an urban and a rural area in Sri Lanka

“…Therefore, our findings contradicted the main hypothesis with regard to human population. This finding is consistent with the research that was conducted to evaluate AMR at the community level in an urban and rural setting in Karnataka, India where it was revealed that AMR was high in community members in both rural and urban settings (Balachandra et al., 2021). In parallel with this study, two separate studies were conducted at the same study sites and results of these studies were already published as journal articles (Gunasekara et al., 2022; Gunasekera et al., 2022); a quantitative survey that was conducted to determine the knowledge, attitudes and perceptions (KAP) on antibiotics and AMR among the general public.…”

“…where it was revealed that AMR was high in community members in both rural and urban settings (Balachandra et al, 2021). In parallel with this study, two separate studies were conducted at the same study sites and results of these studies were already published as journal articles (Gunasekara et al, 2022;Gunasekera et al, 2022); a quantitative survey that was conducted to determine the knowledge, attitudes and perceptions (KAP) on antibiotics and AMR among the general public.…”

Prevalence of antimicrobial resistance in urine, blood, and wound pathogens among rural patients in Karnataka, India

“…We found high rates of resistance of urinary pathogens to aminoglycosides, as has been described in previous studies. 16 …”

“…More than 25% of all K. pneumoniae and Pseudomonas spp isolates showed resistance to imipenem, and a similar proportion of all E. coli, Klebsiella spp and Pseudomonas spp isolates were resistant to fourth-generation cephalosporins. 16 …”

Availability, Prices and Affordability of Antibiotics Stocked by Informal Providers in Rural India: A Cross-Sectional Survey

“…In 2019, 1.27 million deaths were directly attributable to AMR, with the highest burdens in sub-Saharan Africa and South Asia [3]. India, where this study is located, is among the highest AMR-prevalant countries [4], with 50% or more of E. coli, and 30% or more of Klebsiella in rural and urban settings, which are resistant to ciprofloxacin (a quinolone), and first-, second-and thirdgeneration cephalosporins [5][6][7], which are the first-line antibiotic treatments for bacterial diarrhoea and typhoid fever.…”