New Delhi: Multi-drug resistant organisms that were generally found in hospitals are now commonly circulating among the population, causing Community Acquired Infections (CAI) that are resistant to latest generation of antibiotics carrying high mortality.
Researchers from department of critical care, Sir Ganga Ram Hospital and City Hospital in New Delhi, during a retrospective study on over 5,300 patients for two years, have found that classic ‘Hospital’ strains which were drug resistant with high mortality are now spreading in the community too.
The study titled “Association of high mortality with extended–spectrum β-lactamase (ESBL) positive cultures in CAIs", published in the Journal of Critical Care, was done on 201 selected patients among 5,300 who did not come into contact with any health care facility in last three months or more.
ESBLs are organisms—resistant to various newer generation antibiotics and can be easily transferred in the community. These resistant infections pose therapeutic challenges to clinicians in the treatment of these patients and may therefore be associated with high morbidity and mortality.
The study showed that the predominant pathogens isolated from CAIs were E.coli (46.2%) followed by Klebsiella pneumonia (13.9%) and S. aureus (13.9%). “Infections due to multidrug resistant organisms have become a serious health concern worldwide. The present study was conducted to investigate the spectrum of microbial resistance pattern in the community and their effects on mortality. The distinction between community-acquired and hospital-acquired infections is becoming increasingly blurred.
“The main reasons for this are the spread of classical ‘hospital’ strains, particularly resistant Klebseilla and E. Coli, into the community and vice versa, and the repeated admissions of individuals to hospitals with long standing underlying diseases," said Sumit Ray, author of the study and vice-chairman, department of critical care, Sir Ganga Ram Hospital.
Public health experts claim that the contribution of antibiotic resistance in the community through easily available antibiotics often used without medical supervision has resulted in an increasing reservoir of potential infections. “The resistance to high end antibiotics by organisms contracted by patients in the community is resulting in high mortality," Ray said.
Infections due to multidrug resistant gram negative organisms particularly those producing ESBLs are of major concern worldwide. The study has highlighted that the striking point is the emergence of E.coli as most common bacteria in the community causing bacteraemia, respiratory and urinary tract infection and higher mortality in ESBL positive producers as compared to ESBL negative producers.
“A high percentage (63.44%) of these E. coli was ESBL producers. This reflects the increased resistance pattern to high end antibiotics in Hospital Acquired Infections (HAI) due to inadvertent early use of 3rd generation cephalosporins (antibiotics) in the last decade, which is further trickling over into the community, because of transfer of its genetic materials," Ray said.