Antimicrobial Resistant Infections Especially Multi Drug Resistant Tuberculosis(Important) [ ]

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A person has drug resistant TB if the TB bacteria if it does not respond to, and therefore resistant to, at least one of the main TB drugs. Drug susceptible TB is the opposite of drug resistant TB. Drug resistant TB is acquired if TB treatment is inadequate or from the direct transmission.

Image of Burden of Antibiotic Resistance in Indian Neonates

Image of Burden of Antibiotic Resistance in Indian Neonates

Image of Burden of Antibiotic Resistance in Indian Neonates

Main Types of Drug Resistant TB

  • MDR TB bacteria are resistant to the TB drugs rifampicin and isoniazid
  • XDR-TB (extensively drug resistant TB) is resistant to at least rifampicin and isoniazid in addition to strains being resistant to one of the fluoroquinolones, as well as resistant to at least one of the second line injectable TB drugs amikacin, kanamycin, or capreomycin.
  • Totally drug resistant TB, XXDR-TB or TDR-TB is extremely difficult to treat.

MDR-TB and XDR-TB do not respond to six months of TB treatment with “first line” anti TB drugs. And can take two years or more

Statistics on Drug Resistant TB

  • There were an estimated 250, 000 deaths from MDR/RR-TB in 2015 with more than half in India, China, and the Russian Federation.
  • By the end of 2015, extensively drug resistant (XDR) TB reported by 117 countries and territories.
  • Highest prevalence of MDR-TB documented in Minsk, Belarus. This a prevalence of 47.8 % reported in 2011.
  • The 30 “high burden” TB countries are Angola, Azerbaijan, Bangladesh, Belarus, China, DPR Korea, DR Congo, Ethiopia, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Mozambique, Myanmar, Nigeria, Pakistan, Papua New Guinea, Peru, Philippines, Republic of Moldova, Russian Federation, Somalia, South Africa, Tajikistan, Thailand, Ukraine, Uzbekistan, Viet Nam, Zimbabwe.
  • The prevalence of multi drug resistant MDR TB in India is at a low level in most regions- 3 % in new cases and around 12 - 17 % in retreatment cases. However, it translates into large absolute numbers
  • In 2014 India achieved complete geographical coverage for diagnostic and treatment services for multi-drug resistant TB
  • More Statistics can be found:

    • Draft 2015 report on Indian Revised National TB Control Programme from Joint Monitoring Mission
    • Revised National Tuberculosis Control Programme Guidelines on Programmatic Management of Drug Resistant TB (PMDT) in India
    • Standards for TB Care in India

Control of Drug Resistant TB

  • Way forward is to strengthen national TB control program limiting drug resistant TB.
  • Directly confront MDR-TB and XDR-TB with resources and the commitment at local, national, and global level.
  • Need to find people and provide treatment for drug resistant TB to not only save their lives, but also to prevent transmission of drug resistant TB.

Antimicrobial Resistance in India

  • Antibiotic use is a major driver of resistance. Neonates are more prone to infections and vulnerable to ineffective treatment. Sepsis remains a leading cause of mortality and morbidity, especially during the first five days of life and in low and middle-income countries (LMIC).
  • Antibiotics are included in Schedule H and H1 to the Drugs & Cosmetics Rules, 1945, and, cannot be sold in retail except in accordance with the prescription of a Registered Medical Practitioner.

Table contain shows the Antimicrobial Resistance in India

Table contain shows the Antimicrobial Resistance in India

Location (year published)

Isolates

Organism

Resistance rate (%)

MVIDH,

Delhi (2007)

9859 stool samples

V. Cholera 01

96 to furazolidone, Cotrimoxazole and nalidixic acid.

Kolkata (2007)

284 clinical isolates

Metallo-beta-lactamasa (MBL producing bacteria

43.3 were resistant to at least seven antibiotics (ampicillin, amoxicillin, cephalexin, ciprofloxacin, cotrimaxazole, erythromycin, genramycin)

Lucknow (2007)

2995 blood samples

Klebsiellaspp

ESBL producing Klebsiellaspp, were 98.28 resistant to ampicillin, ticarcillin and piperacillin. Monobactem and cephalosporin resistance was also higher ( > 60%).

Puducherry (2008)

261 clinical isolates

Staphylococcus isolates

72.34 of staphylococcus aureus resistant to oxacillin

Nagpur (2009)

1300 nasopharyngeal swabs from school children

MRSA

4.16

CMC Vellore, Various centers across India (2010)

176 clinical specimens

P. Aeruginose

Among the 61 P. aeruginosa Isolates, resistance to carbapenem was 42.6.

Puducherry (2010)

31 clinical samples

K. Pneumoniae

93.55 multiple drug resistant and ESBL producer

Mangalore (2010)

83 CA-MRSA clinical isolates

Community-associated methicillin resistant Staphylococcus aurous (CA-MRSA) strains

92.8 % were resistant to penicillin, 31.32 o erythromycin.

LokNayak Hospital, New Delhi (2010)

83 isolates from OPD cases of pyoderma

CA-MRSA

9.6

Mangalore (2010)

180 clinical samples

Enterococcal strains

16.67 to 42.86 to aminoglycosides

Sikkim (2011)

291 clinical specimens 196 carrier screening nasal samples

MRSA

38.14 in clinical specimens 20.92 in nasal samples

Tertiary trauma center of AIIMS. New Delhi (2011)

3, 984 clinical specimens

Gram Negative

Pseudomonas Acinetobactor Klebsiella E. coli Enterobactor spp. Gram positive S. aureus Coagulase negative staphylococci

Overall resistance of gram negative organisms were 50 against carbapenems, 66 aminoglycosides, 76 Fluoroquinolones, 88 third generation cephalosporins, 66 beta lactam-betalactamese inhibitor combinations 58 methicillin resistant 85 methicillin resistant

  • Antimicrobial resistance is a major public health problem in South East Asian countries including India
  • Infectious disease burden in India among the highest in the world
  • Poor sanitation and malnutrition exacerbates these conditions
  • Various national health programs provide definite policies for appropriate use of antimicrobials like Integrated Management of Neonatal and Childhood Illness (IMNCI) in diarrheal diseases and respiratory infections
  • Local resistance patterns have to be known for appropriate antimicrobial use
  • Hospital data indicates that antibiotic resistance is increasing especially to commonly used antimicrobials in pathogens like Salmonella, Shigella, Vibrio cholerae, Staphylococcus aureus, Neisseria gonorrhoeae, N. meningitidis, Klebsiella, Mycobacterium tuberculosis, HIV, plasmodium and others
  • Resistance for treatment of HIV infection following the rapid expansion in access to antiretroviral medicines
  • Multi-resistant enterobacteriaceae have become very common in India.

Antimicrobial Stewardship, Prevention of Infection and Control (ASPIC), Red Line Campaign and National Programme on Containment of Antimicrobial Resistance

  • Indian Council of Medical Research (ICMR) launched a programme on Antimicrobial Stewardship, Prevention of Infection and Control (ASPIC) in 2012 to not only cut down the rates of nosocomial infections, but also reduce the volume of antibiotic consumption for containing antimicrobial resistance (AMR).
  • Red line campaign regulates over the counter sale of Schedule H antibiotics discouraging unnecessary prescription and over-the-counter sale of antibiotics causing drug resistance for several critical diseases including TB, malaria, urinary tract infection and even HIV.
  • The Ministry of Health & Family Welfare has also launched a programme named ‘National Programme on Containment of Antimicrobial Resistance’ to address the problem of growing AMR.

Clinical Trials for New Medicines

  • Central Licensing Authority i. e. Drugs Controller General (India) approved various clinical trials of Antibiotics on children under one year of age. During the last three years, such clinical trials were approved for Multi Drug Resistant Tuberculosis (MDRTB) and Tuberculosis Meningitis in children.
  • The details of the clinical trials are registered in Clinical Trial Registry of India (CTRI), which is publicly available (www.ctri.nic.in).

- Published/Last Modified on: September 9, 2017