High Burden of Antimicrobial Resistance and Mortality Among Adults and Children With Community-Onset Bacterial Infections in India

Abstract

Background: In India, antimicrobial consumption is high, yet systematically collected data on the epidemiology, risk factors, and outcomes of antimicrobial-resistant infections are limited.

Methods: A prospective study of adults and children hospitalized for acute febrile illness was conducted between August 2013 and December 2015. In-hospital outcomes were recorded, and logistic regression was performed to identify independent predictors of community-onset antimicrobial-resistant infections.

Results: Among 1524 patients hospitalized with acute febrile illness, 133 isolates were found among 115 patients with community-onset infections; 66 isolates (50.0%) were multidrug resistant and, of 33 isolates tested for carbapenem susceptibility, 12 (36%) were resistant. Multidrug-resistant infections were associated with recent antecedent antibiotic use (adjusted odds ratio [aOR], 4.17; 95% confidence interval [CI], 1.19-19.7) and were independently associated with mortality (aOR, 6.06; 95% CI, 1.2-55.7).

Conclusion: We found a high burden of community-onset antimicrobial-resistant infection among patients with acute febrile illness in India. Multidrug-resistant infection was associated with prior antibiotic use and an increased risk of mortality.

Keywords: India.; antimicrobial resistance; clinical isolates; community onset.

Figure 1.

Flow diagram of study enrollments and collection of cultures among adults and children hospitalized for acute febrile illness (AFI) in Pune, India. AMA, against medical advice; CSF, cerebrospinal fluid. ^aOne blood culture, 2 respiratory specimen cultures, and 2 CSF cultures grew 2 organisms. ^bResults of 4 cultures were positive; 1 positive result was already identified by culture of a blood specimen obtained at admission.

Figure 2.

Total, multidrug-resistant, and carbapenem-resistant pathogenic bacterial isolates among adults and children with microbiologically infection by species and classification as community versus hospital onset. Blue bars represent community-onset bacterial infections, orange bars represent hospital-onset bacterial infections. Increasing shading intensity represents broader antimicrobial resistance. Abbreviations: GPC, gram-positive cocci; GNR, gram-negative rod.