ANALYSIS OF THE BIOCHEMICAL PATHWAYS INVOLVED IN DRUG RESISTANCE AMONG BACTERIAL STRAINS ISOLATED FROM PATIENTS ATTENDING TERTIARY CARE HOSPITAL OF SOUTHERN RAJASTHAN
Main Article Content
Keywords
Antimicrobial resistance, blaNDM-1, ESBL, MBL
Abstract
Background: Antimicrobial resistance (AMR) is a global health crisis, particularly in developing countries like India. This study aimed to analyze the biochemical pathways involved in drug resistance among bacterial strains isolated from patients attending a tertiary care hospital in Southern Rajasthan.
Methods: A prospective, observational study was conducted over 12 months, involving 1000 non-duplicate bacterial isolates. Antibiotic susceptibility testing, identification of resistance mechanisms, and molecular characterization of resistance genes were performed. Clinical outcomes were also assessed.
Results: Escherichia coli (32%), Staphylococcus aureus (22%), and Klebsiella pneumoniae (18%) were the most prevalent isolates. High resistance rates were observed for commonly used antibiotics, with 70% of E. coli and 80% of K. pneumoniae resistant to ceftriaxone. ESBL production was the most common resistance mechanism (60% in E. coli, 70% in K. pneumoniae). Molecular analysis revealed a wide distribution of resistance genes, including blaTEM, blaCTX-M, and blaNDM-1. Antibiotic-resistant infections were associated with longer hospital stays, higher ICU admission rates, and increased 30-day mortality.
Conclusion: The study reveals a high prevalence of antibiotic resistance among bacterial isolates in Southern Rajasthan, with significant implications for patient outcomes. The predominance of ESBL production and the emergence of carbapenemase-producing organisms underscore the need for targeted interventions and judicious antibiotic use. These findings emphasize the importance of local and national efforts to address this critical public health challenge.
References
2. Bush, K., & Jacoby, G. A. (2010). Updated functional classification of β-lactamases. Antimicrobial Agents and Chemotherapy, 54(3), 969-976.
3. Chandy, S. J., Naik, G. S., Balaji, V., Jeyaseelan, V., Thomas, K., & Lundborg, C. S. (2013). High cost burden and health consequences of antibiotic resistance: the price to pay. The Journal of Infection in Developing Countries, 7(12), 1096-1102.
4. Hooper, D. C., & Jacoby, G. A. (2015). Mechanisms of drug resistance: quinolone resistance. Annals of the New York Academy of Sciences, 1354(1), 12-31.
5. Lambert, P. A. (2005). Bacterial resistance to antibiotics: modified target sites. Advanced Drug Delivery Reviews, 57(10), 1471-1485.
6. Laxminarayan, R., & Chaudhury, R. R. (2016). Antibiotic resistance in India: drivers and opportunities for action. PLoS Medicine, 13(3), e1001974.
7. Laxminarayan, R., Duse, A., Wattal, C., Zaidi, A. K., Wertheim, H. F., Sumpradit, N., ... & Cars, O. (2013). Antibiotic resistance—the need for global solutions. The Lancet Infectious Diseases, 13(12), 1057-1098.
8. Partridge, S. R., Kwong, S. M., Firth, N., & Jensen, S. O. (2018). Mobile genetic elements associated with antimicrobial resistance. Clinical Microbiology Reviews, 31(4), e00088-17.
9. Patel, G., & Bonomo, R. A. (2013). "Stormy waters ahead": global emergence of carbapenemases. Frontiers in Microbiology, 4, 48.
10. Sun, J., Deng, Z., & Yan, A. (2014). Bacterial multidrug efflux pumps: mechanisms, physiology and pharmacological exploitations. Biochemical and Biophysical Research Communications, 453(2), 254-267.
11. Webber, M. A., & Piddock, L. J. (2003). The importance of efflux pumps in bacterial antibiotic resistance. Journal of Antimicrobial Chemotherapy, 51(1), 9-11.
12. World Health Organization. (2019). Ten threats to global health in 2019. Retrieved from https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
13. Yadav, K. K., Adhikari, N., Khadka, R., Pant, A. D., & Shah, B. (2015). Multidrug resistant Enterobacteriaceae and extended spectrum β-lactamase producing Escherichia coli: a cross-sectional study in National Kidney Center, Nepal. Antimicrobial Resistance and Infection Control, 4(1), 42.
14. Bhattacharya, S., et al. (2011). Extended-spectrum β-lactamase-producing Enterobacteriaceae isolated from patients with urinary tract infections. Indian Journal of Medical Research, 134(3), 362-366.
15. Carling, P., et al. (2003). Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infection Control & Hospital Epidemiology, 24(9), 699-706.
16. Cosgrove, S. E., et al. (2005). The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infection Control & Hospital Epidemiology, 26(2), 166-174.
17. Datta, P., et al. (2012). Evaluation of various methods for the detection of meticillin-resistant Staphylococcus aureus strains and susceptibility patterns. Journal of Medical Microbiology, 61(5), 613-616.
18. de Kraker, M. E., et al. (2011). Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Medicine, 8(10), e1001104.
19. Ensor, V. M., et al. (2009). Occurrence, prevalence and genetic environment of CTX-M β-lactamases in Enterobacteriaceae from Indian hospitals. Journal of Antimicrobial Chemotherapy, 63(3), 550-557.
20. Friedman, N. D., et al. (2008). The negative impact of antibiotic resistance. Clinical Microbiology and Infection, 14(s1), 16-21.
21. Gupta, N., et al. (2011). New Delhi metallo-β lactamase-1 in Enterobacteriaceae: emergence and challenges. Indian Journal of Medical Research, 134(2), 226-232.
22. Joshi, S., et al. (2013). Methicillin resistant Staphylococcus aureus (MRSA) in India: Prevalence & susceptibility pattern. Indian Journal of Medical Research, 137(2), 363-369.
23. Kumar, A., et al. (2006). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine, 34(6), 1589-1596.
24. Kumarasamy, K. K., et al. (2010). Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. The Lancet Infectious Diseases, 10(9), 597-602.
25. Livermore, D. M., et al. (2007). CTX-M: changing the face of ESBLs in Europe. Journal of Antimicrobial Chemotherapy, 59(2), 165-174.
26. Mathai, D., et al. (2008). Epidemiology and frequency of resistance among pathogens causing urinary tract infections in 1,510 hospitalized patients: a report from the SENTRY Antimicrobial Surveillance Program (North America). Diagnostic Microbiology and Infectious Disease, 62(3), 279-283.
27. Nadig, S., et al. (2012). Staphylococcus aureus bacteremia: staphylococcal cassette chromosome mec typing as a predictor of mortality and long-term outcome. Journal of Infection, 65(1), 55-62.
28. Nasa, P., et al. (2012). Incidence of bacteremia and impact of antibiotic resistance in an intensive care unit. Indian Journal of Critical Care Medicine, 16(2), 96-101.
29. Poole, K. (2005). Efflux-mediated antimicrobial resistance. Journal of Antimicrobial Chemotherapy, 56(1), 20-51.
30. Robicsek, A., et al. (2006). Fluoroquinolone-modifying enzyme: a new adaptation of a common aminoglycoside acetyltransferase. Nature Medicine, 12(1), 83-88.
31. Schwaber, M. J., & Carmeli, Y. (2007). Mortality and delay in effective therapy associated with extended-spectrum β-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy, 60(5), 913-920.
32. Taneja, N., et al. (2010). Occurrence of ESBL & Amp-C beta-lactamases & susceptibility to newer antimicrobial agents in complicated UTI. The Indian Journal of Medical Research, 131, 586-590.