Mortality Associated with Community-Acquired Cephalosporin-Resistant Escherichia coli in Patients Admitted to a District Hospital in a Resource-Limited Setting

Abstract

Studies performed in developed countries have shown that infections by third generation cephalosporin resistant Escherichia coli (G3CREC) are associated with increased mortality, but data from developing countries are scarce. In this observational study, we collected clinical and microbiological information of 194 patients admitted to a district hospital in India who had community-acquired isolation of Escherichia coli. The proportion of patients with G3CREC was 79.4%. In a multivariable logistic regression analysis, factors associated with 21-day mortality were isolation from a normally sterile site, HIV infection and isolation of G3CREC. Strains of Escherichia coli isolated from normally sterile sites had lower levels of resistance to quinolones and beta-lactam antibiotics. The proportion of meropenem and ciprofloxacin resistance was 11.1% and 80.9% respectively. The high proportion of G3CREC in the community and the association of G3CREC with 21-day mortality indicate that G3CREC is a major public health problem in developing countries.

High prescription of antimicrobials in a rural district hospital in India

“…The high consumption of antibiotics described in the present study could have an important impact on the appearance of antimicrobial resistance in the community. In fact, we have recently described high rates of methicillin resistant Staphylococcus aureus and third-generation cephalosporin resistant Gram negative bacteria in our setting 19,20…”

Poverty and prevalence of antimicrobial resistance in invasive isolates

“…First, infections caused by resistant organisms are associated with increased mortality and health costs. 2,6,7 Second, antibiotics that are effective against bacteria with AMR are more expensive and are not affordable for a substantial number of people living in resourcelimited settings. 8 Third, increasing the use of effective antibiotics against bacteria with AMR will lead to higher resistance to lastresort antibiotics.…”

Intra-Abscess Administration of Antibiotics Through Ultrasound–Guided Percutaneous Catheter for the Treatment of Pyogenic Liver Abscess

“…The instillation of 500 mg of meropenem inside an abscess can achieve concentrations that are well above the minimal inhibitory concentration (MIC) for most clinically important bacteria [4][5][6]. The half-life of the antibiotic inside the abscess or, more important for time-dependant antibiotics, the amount of time above the MIC will depend on the impermeability of the abscess membrane, the metabolism of the antibiotic by the hepatocytes and the protein…”