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Multidrug-resistant Acinetobacter baumannii infections: looming threat in the Indian clinical setting
Prashant Chandra1, Rajesh V1, Surulivelrajan M1
1Department of Pharmacy Practice, Centre for Pharmaceutical care, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India.
Introduction:
The recent increase in multidrug-resistant strains of A. baumannii has increased the incidences of ventilator-associated pneumoniae, catheter-associated urinary tract infections, and central line-associated blood stream infections, together increasing hospital stay, treatment cost, and mortality. Resistance genes blaOXA and blaNDM are dominant in India. Carbapenem-resistant A. baumannii (CRAB) International clone-2 (IC-2) are rising in India. High dependency on carbapenems and last-resort combination of tigecycline and polymyxins have aggravated outcomes. Despite nursing barriers, ward closure, environmental disinfections etc for detecting and controlling transmission, MDR isolates and CRAB nosocomial outbreaks continue. Treatment cost overruns by AMR adversely affect 80% of Indians without insurance cover.
Area Covered:
This narrative review will cover epidemiology, resistance pattern, genetic diversity, device-related infection, cost, and mortality due to multidrug-resistant and CRAB in India. A comprehensive literature search in PubMed and Google Scholar using appropriate keywords at different time points yielded relevant articles.
Expert Opinion:
It is challenging to enforce policies to control MDR A. baumannii in India. Government and hospitals should enforce stringent infection control measures, surveillance, and antimicrobial stewardship to prevent further spread and emergence of more virulent and resistant strains. Knowledge on antibiotic resistance mechanisms can help design novel antibiotics that can evade, resistance.
Insights
Multidrug-resistant Acinetobacter baumannii (MDR AB) and carbapenem-resistant strains (CRAB) are increasing in India, leading to higher healthcare costs and mortality. Urgent infection control and antimicrobial stewardship are crucial to combat these resistant bacteria.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Rising multidrug-resistant (MDR) Acinetobacter baumannii strains are causing increased ventilator-associated pneumonia, catheter-associated urinary tract infections, and central line-associated bloodstream infections in India.
- Dominant resistance genes blaOXA and blaNDM, along with the emergence of Carbapenem-resistant Acinetobacter baumannii (CRAB) International Clone-2 (IC-2), exacerbate treatment challenges.
- High reliance on carbapenems and last-resort antibiotics like tigecycline and polymyxins has led to poorer patient outcomes and increased mortality.
Purpose of the Study:
- To review the epidemiology, resistance patterns, genetic diversity, device-related infections, economic costs, and mortality associated with MDR and CRAB in India.
- To highlight the challenges in controlling the transmission of MDR Acinetobacter baumannii and CRAB nosocomial outbreaks.
- To emphasize the impact of antimicrobial resistance (AMR) on healthcare costs, particularly for uninsured populations in India.
Main Methods:
- A narrative review approach was employed.
- A comprehensive literature search was conducted using PubMed and Google Scholar with relevant keywords.
- Articles were selected based on their relevance to the epidemiology, resistance, and clinical impact of MDR and CRAB in India.
Main Results:
- MDR and CRAB infections contribute to prolonged hospital stays, increased treatment expenses, and higher mortality rates.
- The prevalence of specific resistance genes and international clones like IC-2 is significant in the Indian context.
- Despite implemented control measures, nosocomial outbreaks of MDR and CRAB continue to pose a threat.
Conclusions:
- Stringent infection control measures, robust surveillance systems, and effective antimicrobial stewardship programs are essential for governments and hospitals to implement.
- Understanding antibiotic resistance mechanisms is vital for developing novel therapeutic strategies against resistant strains.
- Addressing the economic burden of AMR is critical, especially for the large uninsured population in India.
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