High Reported Rates of Antimicrobial Resistance in Indian Neonatal and Pediatric Blood Stream Infections

Dharmapalan, Dhanya; Shet, Anita; Yewale, Vijay

doi:10.1093/jpids/piw092

Cited by 48 publications

(57 citation statements)

References 12 publications

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“…Some of the main factors useful in the prediction of real infection are: 1) similar strains being isolated repeatedly during course of an infection after the isolation of a strain in pure culture from the infected site, 2) in bloodstream infections, patients should have clinical evidence of the infection with one positive blood culture or only two positive CoNS blood cultures within 5 days, and 3) if CoNS is isolated from a skin or soft tissue bacterial culture of a suspected infectious lesion, the isolated organism should be proposed as a pathogen and suitable treatment should be initiated. [35][36][37] Among different-tested antibiotics, the results of our study have revealed that linezolid and vancomycin are effective antibiotics against S. aureus and Enterococcus spp, which was in agreement with the rates reported by Dharmapalan et al from India, 38 He et al from China, 39 Lei Tian et al from China, 40 and Al-Naqshbandi et al from Iraq. 41 However, the results of several studies were not consistent with our research and it has been reported that the resistance to vancomycin is high.…”

Section: Discussionsupporting

confidence: 91%

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<p>Evaluating the antimicrobial resistance patterns among major bacterial pathogens isolated from clinical specimens taken from patients in Mofid Children’s Hospital, Tehran, Iran: 2013–2018</p>

Azimi

Maham

Fallah

et al. 2019

IDR

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Background: This study evaluates the epidemiology and antimicrobial resistance profile of Gram-negative bacteria (GNB) and Gram-positive bacteria (GPB) isolated from clinical specimens in children admitted to Mofid Children's Hospital. Methods: This was a retrospective study of the patients' clinical specimens collected from January 2013 until the end of December 2018. All specimens were evaluated to determine the presence of infection-causing agents using a BACTEC 9120 blood culture. Isolation and identification of bacterial strains were performed using conventional biochemical tests. Antibiotic resistance was determined using Kirby-Bauer disk diffusion and broth microdilution methods. Results were interpreted according to CLSI and EUCAST. Results: A total of 1130 different pathogenic bacteria were detected from 14,690 different clinical specimens and the overall detection rate was 7.7% (1130/14,690). Among bacterial pathogen isolated from clinical specimens, 55% (n=622) were GNB and 45% (n=508) were GPB. The predominant GNB isolates were Pseudomonas aeruginosa, Klebsiella spp., Acinetobacter baumannii, Escherichia coli, Enterobacter spp., Citrobacter spp., respectively. Among GPB, CoNS was the most frequent and Enterococcus spp. was found to have low levels of resistance to linezolid. In GNB, most A. baumannii and P. aeruginosa were ceftriaxone resistant. P. aeruginosa was found to have low levels of resistance to levofloxacin and ciprofloxacin. Conclusions: Our findings revealed that the resistance rate among GNB and GPB associated with different infections in children is very high. These results suggest a constant screening and follow-up programs for the detection of antibiotic resistance, and it also suggests to develop antimicrobial stewardship programs in Tehran, Iran.

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Section: Discussionsupporting

confidence: 91%

“…These finding were in contrast with the results of Mahmoudi et al from Iran 12 and Dharmapalan et al from India. 38 In the current study, among GNB, Proteus spp. and Citrobacter spp.…”

Section: Discussionmentioning

confidence: 54%

<p>Evaluating the antimicrobial resistance patterns among major bacterial pathogens isolated from clinical specimens taken from patients in Mofid Children’s Hospital, Tehran, Iran: 2013–2018</p>

Azimi

Maham

Fallah

et al. 2019

IDR

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“…In the state of Madhya Pradesh in India, where the present study was conducted, National Family Health Survey-4, undertaken in the year 2015-2016, reported that approximately 71% of the children less than 5 years of age were taken to a health facility for complaints of fever in 2 weeks preceding the survey [6]. Studies from India have reported febrile illness due to SBIs, such as pneumonia [7], typhoid fever [8], urinary tract infections (UTIs) [9], blood-stream infections [10], and meningitis [11]. However, as per our knowledge, there is lack of published studies from India on epidemiological or clinical predictors of SBIs among children hospitalized with fever.…”

Section: Introductionmentioning

confidence: 99%

Incidence, clinical profile, and risk factors for serious bacterial infections in children hospitalized with fever in Ujjain, India

et al. 2020

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Background: Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever. Method: This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months-12 years, presenting with fever 100°F (37.7°C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled. Results: A total of 302 children were included in the study, out of which 47% (95% CI 41.4-52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI. Conclusion: The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.

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“…Also, the clinical course of our patient in India was not well documented and details regarding antibiotic and antiviral treatment of the patient are unknown. However, it appears most likely that the patient acquired MDROs while seeking medical treatment in India, where MDRO infection is frequently associated with hospitalization [14][15][16]. Therefore, the risks of MDRO infections associated with medical tourism to regions with high rates of antibiotic resistance should be discussed with patients, who are at higher risk for complications from these organisms.…”

Section: Discussionmentioning

confidence: 99%

Unusual accumulation of a wide array of antimicrobial resistance mechanisms in a patient with cytomegalovirus-associated hemophagocytic lymphohistiocytosis: a case report

et al. 2020

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Background: Infections with multidrug-resistant organisms (MDRO) pose a serious threat to patients with dysregulated immunity such as in hemophagocytic lymphohistiocytosis (HLH), but such infections have rarely been comprehensively characterized. Here, we present a fatal case of HLH secondary to cytomegalovirus (CMV) infection complicated by both anti-viral drug resistance and sepsis from multiple MDROs including pandrug-resistant superbug bacteria. Case presentation: A previously healthy, six-year-old boy presented with a 45-day history of fever prior to a diagnosis of hemophagocytic lymphohistiocytosis and hemorrhagic colitis, both associated with CMV. On hospital admission, the patient was found to be colonized with multiple, multidrug-resistant (MDR) bacteria including vancomycin-resistant enterococci (VRE) and carbapenamase-producing organisms (CPO). He eventually developed respiratory, urine and bloodstream infections with highly drug-resistant, including pandrug-resistant bacteria, which could not be controlled by antibiotic treatment. Antiviral therapy also failed to contain his CMV infection and the patient succumbed to overwhelming bacterial and viral infection. Whole genome sequencing (WGS) of the MDR bacteria and metagenomic analysis of his blood sample revealed an unusual accumulation of a wide range of antimicrobial resistance mechanisms in a single patient, including antiviral resistance to ganciclovir, and resistance mechanisms to all currently available antibiotics. Conclusions: The case highlights both the risk of acquiring MDR superbugs and the severity of these infections in HLH patients.

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High Reported Rates of Antimicrobial Resistance in Indian Neonatal and Pediatric Blood Stream Infections

Cited by 48 publications

References 12 publications

<p>Evaluating the antimicrobial resistance patterns among major bacterial pathogens isolated from clinical specimens taken from patients in Mofid Children’s Hospital, Tehran, Iran: 2013–2018</p>

<p>Evaluating the antimicrobial resistance patterns among major bacterial pathogens isolated from clinical specimens taken from patients in Mofid Children’s Hospital, Tehran, Iran: 2013–2018</p>

Incidence, clinical profile, and risk factors for serious bacterial infections in children hospitalized with fever in Ujjain, India

Unusual accumulation of a wide array of antimicrobial resistance mechanisms in a patient with cytomegalovirus-associated hemophagocytic lymphohistiocytosis: a case report

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