‘Drug of last resort’ losing out to pathogens: ICMR

Aditi Tandon

Tribune News Service

New Delhi, August 14

India is witnessing an alarming rise in the rate of carbapenem-resistant bacteria underlining the need for enhanced antimicrobial surveillance and prevention of antibiotic misuse.

Carbapenem-resistant pathogens are a major public health challenge as carbapenems are the last line of treatment for patients with serious infections.

In its first country report submitted to WHO’s Global Antimicrobial Resistance Surveillance System (GLASS), a platform for global action against antimicrobial resistance (AMR), India has acknowledged the growth of carbapenem-resistant strains in tertiary care settings at home. GLASS was set up in 2015 but India has sent its AMR status to WHO for the first time this year.

“Carbapenem resistance is increasing every year at a very high rate of five to 10 per cent. Overall, the rate of antibiotic resistance to carbapenems in Indian tertiary care settings is anywhere between 50 to 70 per cent. We studied patient isolates from ICUs of 10 tertiary care hospitals and discovered this very worrying trend. The solution lies in controlled use of antibiotics from primary to community to tertiary hospital settings,” says Dr Kamini Walia, in charge, AMR at the Indian Council of Medical Research (ICMR), which compiled India’s annual AMR status report.

Growing carbapenem resistance means increasing inability of the health systems to fight serious and advanced urinary tract infections, lower respiratory tract and bloodstream infections.

Walia says carbapenems are described as “drugs of last resort” because they are the last line of treatment for penicillin-resistant infections where all other antibiotics have failed.

“The only antibiotic left to be administered after carbapenems is colistin which is not a very good drug as it causes high renal toxicity in patients and mandates regular monitoring of patients. Colistin was even discarded in the past but had to be brought back due to emergence of carbapenem-resistant strains,” says Walia.

Another concern ICMR has recorded in the report is increasing resistance of bacteria to new line of antibiotics like Linexolid, Tigecycline and Vaxomycin — all used to treat serious bacterial infections.

“We have observed increasing creeping resistant patterns in new drugs used to treat bacterial infections. This is on account of overuse of drugs in tertiary hospital settings. This needs to change,” Walia told The Tribune.

What’s carbapenems?

Described as ‘drugs of last resort’, they are the last line of treatment for penicillin-resistant infections where all other antibiotics have failed

What’s at risk?

The only antibiotic left to be administered after carbapenems is colistin which is not a very good drug as it causes high renal toxicity in patients and mandates regular monitoring of patients. Colistin was discarded in the past but had to be brought back due to emergence of carbapenem-resistant strains

Its effect

Increasing inability of the health systems to fight serious and advanced urinary tract infections, lower respiratory tract and bloodstream infections

The solution

Controlled use of antibiotics from primary to community to tertiary hospital settings