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Observational Study
. 2019 Aug 1;69(4):563-570.
doi: 10.1093/cid/ciy955.

The Mortality Burden of Multidrug-resistant Pathogens in India: A Retrospective, Observational Study

Sumanth Gandra  1 , Katie K Tseng  1 , Anita Arora  2 , Bhaskar Bhowmik  2 , Matthew L Robinson  3 , Bishnu Panigrahi  2 , Ramanan Laxminarayan  1   4   5 , Eili Y Klein  1   6   7
Affiliations
Observational Study

The Mortality Burden of Multidrug-resistant Pathogens in India: A Retrospective, Observational Study

Sumanth Gandra et al. Clin Infect Dis. .

Abstract

Background: The threat posed by antibiotic resistance is of increasing concern in low- and middle-income countries (LMICs) as their rates of antibiotic use increase. However, an understanding of the burden of resistance is lacking in LMICs, particularly for multidrug-resistant (MDR) pathogens.

Methods: We conducted a retrospective, 10-hospital study of the relationship between MDR pathogens and mortality in India. Patient-level antimicrobial susceptibility test (AST) results for Enterococcus spp., Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. were analyzed for their association with patient mortality outcomes.

Results: We analyzed data on 5103 AST results from 10 hospitals. The overall mortality rate of patients was 13.1% (n = 581), and there was a significant relationship between MDR and mortality. Infections with MDR and extensively drug resistant (XDR) E. coli, XDR K. pneumoniae, and MDR A. baumannii were associated with 2-3 times higher mortality. Mortality due to methicillin-resistant S. aureus (MRSA) was significantly higher than susceptible strains when the MRSA isolate was resistant to aminoglycosides.

Conclusions: This is one of the largest studies undertaken in an LMIC to measure the burden of antibiotic resistance. We found that MDR bacterial infections pose a significant risk to patients. While consistent with prior studies, the variations in drug resistance and associated mortality outcomes by pathogen are different from those observed in high-income countries and provide a baseline for studies in other LMICs. Future research should aim to elucidate the burden of resistance and the differential transmission mechanisms that drive this public health crisis.

Keywords: antimicrobial resistance; health care–acquired infections; low- and middle-income countries; multidrug-resistant organisms.

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Figures

Figure 1.
Figure 1.
Study inclusion/exclusion flowchart of AST results. Abbreviations: AST, antimicrobial susceptibility testing; ICU, intensive care unit.
See this image and copyright information in PMC

Comment in

  • Reply to Chopra and Rizvi.
    Gandra S, Arora A, Laxminarayan R, Klein EY. Gandra S, et al. Clin Infect Dis. 2019 Sep 13;69(7):1265-1266. doi: 10.1093/cid/ciz128. Clin Infect Dis. 2019. PMID: 30753356 Free PMC article. No abstract available.
  • Antimicrobial Resistance in Low- and Middle-income Countries.
    Chopra S, Rizvi M. Chopra S, et al. Clin Infect Dis. 2019 Sep 13;69(7):1264-1265. doi: 10.1093/cid/ciz127. Clin Infect Dis. 2019. PMID: 30753365 No abstract available.

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