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. 2017 Apr 15;215(8):1312-1320.
doi: 10.1093/infdis/jix114.

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

Vidya Mave  1   2 , Ajay Chandanwale  1   2 , Anju Kagal  1   2 , Sandhya Khadse  1   2 , Dileep Kadam  1   2 , Renu Bharadwaj  1   2 , Vaishali Dohe  1   2 , Matthew L Robinson  1   2 , Aarti Kinikar  1   2 , Samir Joshi  1   2 , Priyanka Raichur  1   2 , Katie McIntire  1 , Savita Kanade  1   2 , Jonathan Sachs  3 , Chhaya Valvi  2 , Usha Balasubramanian  1   2 , Vandana Kulkarni  1   2 , Aaron M Milstone  1 , Ivan Marbaniang  1   2 , Jonathan Zenilman  1 , Amita Gupta  1   2
Affiliations

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

Vidya Mave et al. J Infect Dis. .

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.

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Figures

Figure 1.
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.
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.
See this image and copyright information in PMC

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