Back20% of patients in India resistant to last-resort antibiotics
Resistance to carbapenems effectively means patients with life-threatening infections are left with no options
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New Delhi: About 20% of patients in India have become resistant to carbapenems, the most advanced class of antibiotics, a survey has found, showing that the fight against potentially fatal infections is getting tougher.
The National Centre for Disease Control (NCDC), which functions under the health ministry, came up with the finding from a surveillance programme it started last year at seven tertiary-care government hospitals.
Resistance to carbapenems, a class of antibiotics used as a last resort to treat serious and potentially lethal infections, was found in 13-30% of patients observed, with an average of 20% across hospitals surveilled, according to the study.
Patients at three health facilities in Delhi—Ram Manohar Lohia Hospital (30%), Lady Hardinge Medical College (28%) and Safdarjung Hospital (26%)—and one in Pune—Byramjee Jeejeebhoy Government Medical College (28%)—showed the highest rates of resistance.
The other three hospitals observed were Government Medical College and Hospital, Chandigarh (23%), Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur (19%) and Byramjee Jeejeebhoy Medical College, Ahmedabad (13%).
“Overuse of one particular set of antibiotics makes people resistant to them. We have been using carbapenems far more than we should," said Chand Wattal, chairman of the department of microbiology at Sir Ganga Ram Hospital in New Delhi. “It makes treatment of critical patients difficult, including patients going through cancers, transplants and admitted in intensive care units."
Resistance to carbapenems effectively means that patients with life-threatening infections are left with no other option for treatment of fatal infections. It could take up to eight years for alternative treatments to come to the market, underlining the gravity of the situation.
Resistance to antibiotics could impede the treatment of patients suffering a range of health ailments—from urinary tract infections and renal failure to cancers and blood infection.
“Resistance to carbapenems is creating a scary scenario. These antibiotics are the most recent. They have been available in the market only for 15 years and are used primarily in hospital settings for patients who have a compromised immune system," said Sunil Gupta, joint director, division of microbiology, NCDC, who is overseeing the surveillance programme.
“Patients resistant to carbapenems are unable to fight infections, which can get fatal," Gupta said. Some 80-90% of patients resistant to carbapenems are also resistant to other commonly used antibiotics, according to Gupta.
The surveillance programme is now being expanded to smaller government hospitals and clinics to determine resistance levels among less vulnerable patients and the healthy.
Another study by the Indian Council of Medical Research (ICMR), conducted in 2013-2015 in Kanpur, meanwhile, found that 2% of even healthy people had developed resistance to carbapenems.
“We found 2% of common people resistant to this antibiotic, and 4% of patients who were not severely ill," said Atul Garg, lead author of the study and head of the department of microbiology at Ganesh Shankar Vidyarthi Memorial Medical College in Kanpur. “This is a dangerous sign. If these healthy people need major treatment like kidney transplant later in life, then they will find it difficult in absence of important antibiotics like carbapenem."
Taking note of these findings, health minister J.P. Nadda launched the “Hospital Infection Control Guidelines" on 23 February.
The guidelines said carbapenems should be used to treat only the seriously ill. The guidelines are voluntary and do not suggest any punitive action if hospitals and doctors don’t follow them.
NCDC’s data shows that up to 70% of patients have become resistance to common antibiotics. “In this situation, we need to develop a new set of antibiotics, which will more advanced than carbapenems," said Garg.
Antibiotics are at different stages of development at Indian pharmaceutical companies, but not one drug maker is ready with a marketable medicine.
“The trend world over is that developing antibiotics is not a priority for big pharmaceutical companies. India, on the other hand, focuses more on research on generic medicines. But lately, some companies like Vitas Pharma and Wockhardt have started research and development for antibiotics in the country," said Radha Rangarajan, founder and CEO, Vitas Pharma Pvt. Ltd.
“Vitas Pharma has developed a new set of drugs which are in pre-clinical trial phase. However, it will take seven to eight years to roll out medicines in the market. Clinical trials and registration take time, apart from arranging for funding," she said.
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