Superbugs, or drug-resistant micro-organisms, were found in 3,080 blood samples and another 792 urine samples, according to the newly formed Healthcare Associated Infection Surveillance-India. The presence of superbugs is an indicator of resistance to older antibiotics and the need for last-resort antibiotics such as carbapenem and colistin that are expensive and need IV infusions. Such antibiotic or antimicrobial resistance was recently flagged off by the World Health Organisation as a mega public health threat.
The HAI-Surveillance India is a central government effort between All India Institute of Medical Sciences (AIIMS-Delhi), the Indian Council for Medical Research (ICMR) and the US Center for Diseases Control. HAI is an infection that a patient gets by the virtue of being in a hospital for long — for instance, a patient with an invasive ventilator or urinary catheter.
Most doctors know that ICU patients in India who stay for longer periods get infected by gram-negative micro-organisms, which are more difficult to treat than gram-positive organisms found in western world ICUs.
“The findings confirmed the extent of these gram-negative infections,” said head of AIIMS microbiology department Dr Purva Mathur, who leads the project. The survey found that gram negative bacteria was widespread, accounting for 73.3% of all blood infections cases and 53.1% of UTI cases in Indian ICUs.
Also, it found 38.1% of the patients with bloodstream infections and another 27.9% with urinary tract infections died within a 14-day period (the study, however, mentioned that HAI in these cases were possibly only associated complications that didn’t contribute to death directly).
“ICUs are hotbeds for healthcare-acquired infections. The results underline that we need to put in place better hospital infection control practices and adopt stewardship practices that will reduce the irrational use of antibiotics,’’ said ICMR scientist Dr Kamini Walia who is incharge of the overall antimicrobial resistance studies in India.
Unlike the overall ICMR report, the HAIS report only looked at ICUs; Dr Wali said it not only found widespread antibiotic resistance, it also found evidence of drug-resistant fungal infections.
To check the emergence of newer superbugs, doctors such as Dr Lancelot Pinto from Hinduja Hospital said: “We could have an audit on the use of higher antibiotics among hospitals that will reveal how many hospitals follow the rules”. Most importantly, HAI surveillance provides a benchmark for hospitals. “If we say a hospital has an HAI rate of 4 per 1,000 then one would know how it compares with other hospitals,” said Dr Mathur.