Current Perspectives on Treatment of Gram-Positive Infections in India: What Is the Way Forward?

Abstract

The emerging antimicrobial resistance leading to gram-positive infections (GPIs) is one of the major public health threats worldwide. GPIs caused by multidrug resistant bacteria can result in increased morbidity and mortality rates along with escalated treatment cost and hospitalisation stay. In India, GPIs, particularly methicillin-resistant Staphylococcus aureus (MRSA) prevalence among invasive S. aureus isolates, have been reported to increase exponentially from 29% in 2009 to 47% in 2014. Apart from MRSA, rising prevalence of vancomycin-resistant enterococci (VRE), which ranges from 1 to 9% in India, has raised concerns. Moreover, the overall mortality rate among patients with multidrug resistant GPIs in India is reported to be 10.8% and in ICU settings, the mortality rate is as high as 16%. Another challenge is the spectrum of adverse effects related to the safety and tolerability profile of the currently available drugs used against GPIs which further makes the management and treatment of these multidrug resistant organisms a complex task. Judicious prescription of antimicrobial agents, implementation of antibiotic stewardship programmes, and antibiotic policies in hospitals are essential to reduce the problem of drug-resistant infections in India. The most important step is development of newer antimicrobial agents with novel mechanisms of action and favourable pharmacokinetic profile. This review provides a synopsis about the current burden, treatment options, and the challenges faced by the clinicians in the management of GPIs such as MRSA, Quinolone-resistant Staphylococcus, VRE, and drug-resistant pneumococcus in India.

Antibiotic Susceptibility Pattern of Methicillin Sensitive and Resistant Staphylococcus aureus from Clinical Isolates in a Tertiary Care Hospital at Mathura, Western Uttar Pradesh

“…Data on the prevalence of MRSA is not uniform. Literature has documented a significant variation in the prevalence rate from different parts of India and between countries [1][2][3][4][5][6][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] . Studies from India report MRSA prevalence ranging from 6.9% to 87% 9 .…”

“…In the early 1960s, Methicillin Resistant S.aureus (MRSA) emerged as a potential pathogen causing nosocomial colonization, several outbreaks and difficult-to-treat infections like bacteremia, infective endocarditis, osteoarticular and pleuropulmonary infections. They also causes device related infections like central line associated blood stream infections, ventilator associated pneumonia and catheter associated urinary tract infections [1][2][3][4][5] . It always remains a challenge for physicians to treat and control MRSA infections.…”

“…As reviewed by Gupta et al, 6 nosocomial infections caused by MRSA increased from 30% in 1990's to 80% in 2010 in many countries. In India, it varies from 29% in 2009 to 47% in 2014 3 . This increasing rate of infections caused by MRSA pose a serious treat causing extensive difficult to control outbreaks.…”

Overview of methicillin resistant Staphylococcus aureus mediated bone and joint infections in India

“…46,47 WCK 771 when dosed at 800 mg intravenously and its pro-drug (WCK 2349) dosed at 1000mg orally in clinical trials attained a half-life of 6 h, a concentration that when dosed BID systemically has been effective to treat MRSA infections. 48,49…”

The Role of Proteomics in Bacterial Response to Antibiotics

“…Specifically, the most challenging infections are caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate S. aureus (VISA), vancomycin-resistant S. aureus (VRSA), and vancomycin-resistant enterococci (VRE). The emergence of such strains also leads to an increase in the cost of treating infections caused by Gram-positive bacteria [ 12 ]. The pathogen list contains also the ESKAPE pathogens ( Enterococcus faecium , S. aureus , Klebsiella pneumoniae , Aacinetobacter baumannii , P. aeruginosa, and Enterobacter species) which are considered to be the leading cause of nosocomial infections [ 13 ] with the highest risk of mortality [ 14 ].…”