Current clinical trends in the management of gram positive infections in Indian critical care settings: a survey

Abstract

Background: In India, gram-positive infections (GPIs) particularly, methicillin-resistant Staphylococcus aureus (MRSA) prevalence is reported to increase exponentially. The overall mortality rate among patients with multi drug resistant GPIs in ICU setting are as high as 16%, despite the availability of various therapeutic options. Aim of the study is to determine the burden of GPIs in critical care settings and to understand the practising behaviour among the specialists in the management of MRSA infections.Methods: The survey was conducted among 264 critical care specialists who attended the Annual National Conference of Indian Society of Critical Medicine held in February 2019 at Mumbai. The delegates were administered a validated 10 question survey.Results: In the survey, 72% of the respondents agreed to the rising prevalence of MRSA and associated increased mortality rate of >16%. Empirical gram positive cover is being given to 30-40% of ICU patients, with ABSSSI being listed as a major indication followed by CAP, VAP, CLABSI and DFI. 46% of the doctors listed vancomycin as their preferred anti-MRSA agents followed by teicolplanin and linezolid. However, more than 80% of the doctors feel that nephrotoxicity in vancomycin, thrombocytopenia in linezolid and poor biofilm penetration are major limitations of these anti-MRSA agents.Conclusions: The survey highlighted the increasing trend in the prevalence and associated mortality in GPIs in critical care settings in India. Further, the limitations of existing anti-MRSA agents have invoked the need for a newer agent with a broad spectrum anti-bacterial activity along with improved safety profile and effective biofilm penetration, which can be used as a suitable alternative empiric therapy to manage GPIs.

A Systemic Literature Review and Meta-Analysis Reporting the Prevalence and Impact of Methicillin-ResistantStaphylococcus aureusInfection in India

“…Ultimately, only 34 of 40 studies were included in the MRSA meta-analysis, 8,9,15 -46 as the remaining 6 studies did not include data relevant to MRSA (4 efficacy studies, 1 study that described heteroresistance to vancomycin among methicillin-resistant S. aureus isolates, and 1 survey wherein no exact data on prevalence were presented). 47 -52 Table 1 represents the characteristics of the studies included in the analysis. The studies included in the systematic literature review did not include randomized controlled trials so risk-bias analysis was not performed.…”

“…50 The survey conducted by Rampal et al, indicated an increasing trend in the prevalence and associated mortality in Grampositive bacterial infections in critical care settings in India. 52 The limitations of the existing anti-MRSA agents necessitate the development of a newer agent with a broad spectrum antibacterial activity along with an improved safety profile.…”

Real-World Evidence of Efficacy and Safety of Levonadifloxacin (Oral and IV) in the Management of Acute Bacterial Skin and Skin Structure Infections (ABSSSI): Findings of a Retrospective, Multi-Center Study

“…A survey of the trends in the management of GPIs in Indian critical care settings highlighted an increasing trend in prevalence and associated mortality with GPIs [12]. To address the challenge of growing multidrugresistant pathogens and limitations associated with existing anti-MRSA agents, there is a need for a new suitable empirical agent with an improved safety profile, especially in the ICU [9]. The Infectious Disease Society of America guidelines emphasizes adequately controlling the source of infection, such as draining abscesses and debridement of nonviable tissues irrespective of the AMAs used [13].…”

“…In India, high rates of MRSA have been reported among the S. aureus pool in clinical isolates from various studies, with rates as high as 54.8% (range, 32% to 80%) [8]. Despite the availability of various antimicrobial agents (AMAs), the intensive care unit (ICU) mortality in patients with multidrug-resistant Gram-positive infections (GPIs) is up to 16% [9].…”