Antibiotic resistance in patients with urinary tract infections in Pakistan

Bullens, M.; Melo, A. de Cerqueira; Raziq, S.; Lee, J.; Khalid, G. G.; Khan, S. N.; Zada, A.; Atta-Ur-Rehman,; Wailly, Y.; Zeshan, S. M.; Saad, N. J.; Cuesta, Julita Gil; Williams, Anita

doi:10.5588/pha.21.0071

Cited by 15 publications

(19 citation statements)

References 9 publications

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“…Previous studies have indicated the non-judicious use of quinolones in hospitalized individuals, where a significant proportion of these antimicrobials are administered prophylactically to prevent hospital-acquired infections. Second, ciprofloxacin is widely used for the treatment of urinary tract infections, the most common complaint in adults requiring antibiotic treatment [ 40 ]. Additionally, quinolones are also prescribed extensively for the treatment of upper and lower respiratory tract infections, in most cases without sensitivity testing [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Regional and National Trends in Consumption of Antimicrobials in Pakistan; Pre and Post-COVID (2019–2021)

Mustafa,

Niazi,

Lakdawala

et al. 2023

Clinical Infectious Diseases

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Background Efforts to combat antimicrobial resistance, a growing public health problem in Pakistan, have been hampered by the lack of high-quality national and provincial-level antimicrobial consumption data. The singular objective of this retrospective study was to measure antimicrobial consumption over 3 years between 2019 and 2021. Methods The study was designed to estimate antimicrobial consumption at National and Regional levels. Antimicrobial consumption data was collected by IQVIA covering 110 districts of Pakistan in which 88% of sales are census (accurate sales collected directly from distributors), whereas 12% of sales (sales of 300 pharmacies) are projected on the national level. To determine the usage for 3 consecutive years, the consumption of antibiotics was calculated as defined daily doses (DDD) of antibiotics per 1000 inhabitants per day (DID). Results The results of our study demonstrated a steep increase in the consumption of antimicrobials from 2019 to 2021. An increase in consumption of most classes of antibiotics was observed both nationally and Regionally. Quinolones, penicillins (co-amoxiclav), macrolides, and third-generation cephalosporins remained the most frequently used antibiotics nationally. A 40% increase in intravenous use of antimicrobials was observed between 2019 and 2021 at the national level. Moxifloxacin, Levofloxacin, Ciprofloxacin, and linezolid were the most commonly used intravenous antibiotics. Region 7 (Peshawar) demonstrated the highest consumption, followed by Region 1 (Karachi) and Region 6 (Faisalabad). Among the most commonly used antibiotics, the use of third-generation cephalosporin (cefixime), quinolones, penicillins (amoxicillin + clavulanic acid), and macrolides (azithromycin) was most noticeable in all regions, particularly in those with the higher consumption of antibiotics. Conclusions Although the increase in consumption of all antibiotics is concerning, the steep increase in the use of watch and reserve category antibiotics during the study period calls for immediate actions to limit and regulate their usage.

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Section: Discussionmentioning

confidence: 99%

Regional and National Trends in Consumption of Antimicrobials in Pakistan; Pre and Post-COVID (2019–2021)

Mustafa,

Niazi,

Lakdawala

et al. 2023

Clinical Infectious Diseases

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“…It is, therefore, imperative that the principles of an ASP are applied to both the inpatient and outpatient settings, to truly have a significant impact on reducing the threat of antimicrobial resistance [ 42 ]. Furthermore, an ASP in the outpatient setting must be designed in a way that can be adapted by a variety of institutions with ease and efficiency, regardless of the facilities’ finances, endorsements, and resources available [ 3 ].…”

Section: Artificial Intelligence Vs Antibiotic Stewardship Programmentioning

confidence: 99%

“…However, the widespread use of antibiotics in clinical practice has resulted in drug resistance, in addition to increasing the threat of super-resistant bacteria emergence [ 2 ]. Antimicrobial resistance (AMR) is anticipated to cause around 10 million deaths per year by 2050, and the economic impact of AMR is expected to approach USD 100 billion during the same period [ 3 ]. It is imperative that required efforts to implement new regulations and revive research efforts to manage the AMR epidemic are carried out to address this crisis [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Application of Artificial Intelligence in Combating High Antimicrobial Resistance Rates

et al. 2022

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Artificial intelligence (AI) is a branch of science and engineering that focuses on the computational understanding of intelligent behavior. Many human professions, including clinical diagnosis and prognosis, are greatly useful from AI. Antimicrobial resistance (AMR) is among the most critical challenges facing Pakistan and the rest of the world. The rising incidence of AMR has become a significant issue, and authorities must take measures to combat the overuse and incorrect use of antibiotics in order to combat rising resistance rates. The widespread use of antibiotics in clinical practice has not only resulted in drug resistance but has also increased the threat of super-resistant bacteria emergence. As AMR rises, clinicians find it more difficult to treat many bacterial infections in a timely manner, and therapy becomes prohibitively costly for patients. To combat the rise in AMR rates, it is critical to implement an institutional antibiotic stewardship program that monitors correct antibiotic use, controls antibiotics, and generates antibiograms. Furthermore, these types of tools may aid in the treatment of patients in the event of a medical emergency in which a physician is unable to wait for bacterial culture results. AI’s applications in healthcare might be unlimited, reducing the time it takes to discover new antimicrobial drugs, improving diagnostic and treatment accuracy, and lowering expenses at the same time. The majority of suggested AI solutions for AMR are meant to supplement rather than replace a doctor’s prescription or opinion, but rather to serve as a valuable tool for making their work easier. When it comes to infectious diseases, AI has the potential to be a game-changer in the battle against antibiotic resistance. Finally, when selecting antibiotic therapy for infections, data from local antibiotic stewardship programs are critical to ensuring that these bacteria are treated quickly and effectively. Furthermore, organizations such as the World Health Organization (WHO) have underlined the necessity of selecting the appropriate antibiotic and treating for the shortest time feasible to minimize the spread of resistant and invasive resistant bacterial strains.

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“…WHO GLASS (Global Antimicrobial Resistance and Use Surveillance System) report of 2017-2018 points out resistance of >70% towards ceftriaxone and ciprofloxacin in E. coli isolated from urinary tract infection in Pakistan 4 . In Pakistan resistance to Fosfomycin is low as there was only one reported case in the Bullens et al study in an isolate of E. coli 5 . Resistance to Fosfomycin from other parts of the world is reported as 8.3% in Italy, 4.6% in Spain, 2.9% in the UK (United Kingdom), and 1.9% from Belgium and Russia 6 .…”

Section: Introductionmentioning

confidence: 95%

Fosfomycin Resistance in Clinical Isolates of Escherichia coli from Urinary Tract Infections in a Tertiary Care Hospital

2023

PJMD

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Background: Fosfomycin is called an old-new antibiotic, because it was reintroduced for the treatment of urinary tract infections. The rampant use of antibiotics has led to Fosfomycin resistance reported from different parts of the world. The purpose of this study was to find out the frequency of Fosfomycin resistance in clinical isolates of Escherichia coli (E. coli) from urinary tract samples. Methods: This cross-sectional study, including n=314 patients, was conducted in the Microbiology laboratory at Pakistan Naval Ship SHIFA Hospital, Pakistan from January to June 2022. Urine samples were inoculated on agar at 37±2°C for 24-48hrs. The growth of E. coli was confirmed by API 10S as per recommended Clinical Laboratory Standard Institute (CLSI) guidelines. Susceptibility testing was performed by the standard Kirby Bauer Disc Diffusion method. The Chi-square test was applied to categorical variables. p-value ≤ 0.05 was considered statistically significant. Results: Out of 314 clinical isolates, 171 (54.5%) were females and 143 (45.5%) were males (mean age 49±10.3 (6-81) years). Sixty-six (21%) isolates were found resistant to Fosfomycin while 248 (79%) were sensitive. A significant difference was found between the gender (p=0.035), whereas, 29 (17.0%) females and 37 (25.9%) males were found resistant to Fosfomycin. Conclusion: The resistance to Fosfomycin is increasing and it is an impending threat as oral treatment options are limited in urinary tract infections. However, improved surveillance may help in controlling nosocomial infection along with the rational use of antibiotics can prevent and reduce its spread. Keywords: Fosfomycin; Culture; Susceptibility; Urinary Tract Infections (UTIs).

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Antibiotic resistance in patients with urinary tract infections in Pakistan

Cited by 15 publications

References 9 publications

Regional and National Trends in Consumption of Antimicrobials in Pakistan; Pre and Post-COVID (2019–2021)

Regional and National Trends in Consumption of Antimicrobials in Pakistan; Pre and Post-COVID (2019–2021)

Application of Artificial Intelligence in Combating High Antimicrobial Resistance Rates

Fosfomycin Resistance in Clinical Isolates of Escherichia coli from Urinary Tract Infections in a Tertiary Care Hospital

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