AsianScientist (Nov. 28, 2018) – Scientists in India and the US have found that in-hospital mortality is significantly higher among patients infected with multi-drug resistant (MDR) or extensively drug resistant (XDR) pathogens. They published their findings in Clinical Infectious Diseases.
MDR and XDR Gram-negative bacterial infections are frequent in India and the availability of effective antibiotic therapies are declining. In one of the largest studies to measure the burden of antibiotic resistance in a low- or middle-income country, an international team of scientists led by Dr. Eili Klein of the Center for Disease Dynamics, Economics & Policy, US, analyzed antimicrobial susceptibility testing results and mortality outcomes for over 4,000 patients who visited one of ten tertiary or quaternary referral hospitals across India in 2015.
The pathogens were classified as MDR or XDR based on drug susceptibility profiles proposed by the European and US Centers for Disease Control and Prevention. Mortality data was restricted to in-hospital deaths. The researchers also collected additional demographic and clinical data, including age, sex, place of infection acquisition and location in the hospital, differentiating between intensive care unit (ICU) or non-ICU cases.
The overall mortality rate among all study participants was 13.1 percent, with mortality as high as 29.0 percent among patients infected with Acinetobacter baumannii. Patients who died were more likely to have been older and admitted to the ICU at the time of testing. The researchers also found that among MDR infections, those caused by Gram-negative bacteria were associated with higher mortality rates compared to those caused by Gram-positive bacteria, with rates of 17.7 percent and 10.8 percent, respectively.
The researchers concluded that patients who acquired MDR bacterial infections were 1.57 times more likely to die, compared to patients with similar susceptible infections. Patients who acquired XDR infections were 2.65 times more likely to die when accounting for age, sex, site of infection and the number of coinfections.
Furthermore, the scientists demonstrated that in both the ICU and non-ICU cases, odds of mortality were higher among patients with XDR infections. This association was driven by Gram-negative infections such as XDR Klebsiella pneumoniae, highlighting the importance of rapidly identifying these infections among all patients.
The study authors noted that their methodology should help to quantify and track the burden of resistance across low- and middle-income countries, as well as aid in the development of policies that prioritize antibiotic resistance as a global public health threat.
The article can be found at: Gandra et al. (2018) The Mortality Burden of Multidrug-resistant Pathogens in India: A Retrospective Observational Study.
———
Source: Center for Disease Dynamics, Economics & Policy; Photo: Shutterstock.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.
