Current trends in antimicrobial resistance of ESKAPEEc pathogens from bloodstream infections - Experience of a tertiary care centre in North India

Abstract

Introduction: Bloodstream infections (BSI) due to ESKAPEEc pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanni, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli), cause significant mobility and mortality worldwide and are among the most common healthcare associated infections. Rising rates of antimicrobial resistance (AMR) in India are alarming, because of the high infection rates and poor control of antibiotic use. This single-centre, retrospective study was undertaken to identify the patterns of distribution and antimicrobial resistance of ESKAPEEc pathogens in bloodstream infections.

Methodology: Blood samples from patients with suspected BSI were cultured and antimicrobial susceptibility testing was performed on automated systems (BD Bactec Fx/BactAlert 3D and Vitek2). The microbiological data on bacterial BSI was retrieved from the laboratory records and antimicrobial resistance profiles were analysed.

Results: 10.7% of the blood culture samples showed bacterial growth during the study period (adult > paediatric and intensive care unit (ICU) > ward > outpatient department (OPD)). E. coli (24%) and K. pneumoniae (20.5%) were the predominant species isolated, followed by S. aureus (9.5%) and A. baumanni (9%). High rates of resistance to third generation cephalosporins, β-lactam-β-lactamase inhibitor combinations (BL-BLI) and carbapenems was observed, in Gram-negative isolates, especially from ICU patients. Methicillin-resistant S. aureus (MRSA) isolates increased from 67% to 88% over the five-year period. Vancomycin-resistance among Enterococcus isolates also escalated to 40% in 2022 with 11% linezolid resistance.

Conclusion: The study revealed that more than 77% of bloodstream infections were caused by ESKAPEEc pathogens, with high rates of resistance to most antimicrobials. This reinforces the importance of monitoring the frequency of bacteria and antibiograms in individual treatment and hospital infection control programs.

Keywords: Antimicrobial resistance; Bloodstream infections; ESKAPEEc; Trends.