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Kerala has become the first State in the country to bring out an antibiogram. The State’s first antibiogram (2021) shows that antimicrobial resistance (antibiotic resistance in bacteria that cause either community infections or hospital acquired infections) is definitely on the rise in the State when compared to the previous years.
An antibiogram is the clinical data summarising the profile of various bacterial pathogens and its susceptibility to antibiotics that are meant to treat them. Antibiograms help guide the clinicians in selecting the best empiric antimicrobial treatment and are useful for monitoring trends in drug resistance.
The State’s antibiogram for 2021 has been formed by collating antimicrobial resistance (AMR) surveillance data from 18 sentinel sites across nine districts in the State.
The data shows that ESBL production (ESBL are enzymes that confer resistance to most beta-lactam antibiotics, including penicillins, cephalosporins) has been rising in the State, while at the same time, resistance to Carbapenems, one of the last resort antibiotics that can treat ESBL-producing bacteria, has also been rising.
“Kerala’s AMR profile may fare better when compared to the national AMR surveillance data collated by the ICMR. But this is the time to act. Stringent infection prevention and control measures should be adopted in our healthcare settings and rational antibiotic prescription and use be promoted in the community. It is the only way to break this vicious cycle, wherein increased reliance on last-resort antibiotics to treat infections is also increasing the resistance of organisms to these drugs,” says R. Aravind, Head of Infectious Diseases, Government Medical College, Thiruvananthapuram, and the convener of the working committee of Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP).
Under the KARSAP, district-level AMR committees have now been set up to promote antibiotic literacy in the community. Kerala’s AMR surveillance data pertains to seven priority pathogens—Escherichia coli, Klebsiella species, Pseudomonas species, Acinetobacter species, Salmonella enterica serotype Typhi and Paratyphi, Staphylococcus aureus, and Enterococcus species.
A total of 21,765 priority pathogens isolated from clinical samples of 14,353 unique patients, from January to December 2021, were analysed.
The surveillance data revealed Escherichia coli as the most commonly isolated pathogen (40%), followed by Klebsiella species (24%), Staphylococcus aureus (12%), Pseudomonas species (11%), Enterococcus species (7%), and Acinetobacter species (6%).
E.coli is the most common pathogen isolated among outpatients and inpatients, while Klebsiella species is the commonest pathogen isolated in ICU patients.
Klebsiella spp. isolates showed more than 30% resistance to all the beta lactam antibiotics tested. It also showed alarmingly high resistance to 3rd and 4th generation Cephalosporins (75% to Cefotaxime, 70% to Cefepime) and Carbapenem (39% to Imipenem, 47% to Meropenem) in ICU patients. In infections with Carbapenem-resistant Klebsiella, mortality is around 30%.
The percentage of Methicillin-resistant S. aureus (MRSA) isolates is 20%. This apparent decrease in MRSA is attributed to issues in data collection in the pandemic year.
The resistance to 3rd and 4th generation Cephalosporins among E. coli is 62% and 48% respectively. Among the anti-pseudomonal drugs, 40% isolates of Pseudomonas spp. isolated from ICU patients are resistant to Ceftazidime whereas Piperacillin/tazobactam resistance is observed in 20% of the isolates. Isolates of Acinetobacter spp. show more than 50% resistance to almost all the antibiotics tested except for Minocycline to which 38% of strains are resistant.
Efficient infection control and prevention methods can reduce healthcare-associated infections and at the same time, antimicrobial stewardship should be promoted in a big way.
The public needs to be made aware of how misuse and overuse of antibiotics can make infectious organisms resistant to these very drugs. Doctors point out that 90% of the fevers are caused by viruses against which antibiotics are useless. Azithromycin is the most abused antibiotic, as evidenced during the COVID-19 pandemic.
The State intends to generate the AMR surveillance report every year. The AMR surveillance sites have been increased to 21 now.
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