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Stewardship / Resistance Scan for Sep 07, 2021

Stewardship / Resistance Scan for Sep 07, 2021

Study describes impact of XDR typhoid on young children

A new study by researchers in Pakistan details the impact and response to treatment among children diagnosed as having extensively drug-resistant (XDR) typhoid infections.

The study, published late last week in BMC Infectious Diseases, reviewed the records of 680 children who had culture-proven XDR Salmonella enterica serovar Typhi infections and were treated at a hospital in Karachi at any point from July 2017 to December 2018.

The World Health Organization estimates that there were 5,247 cases of XDR Salmonella Typhi—which is resistant to five classes of antibiotics—in Karachi from November 2016 to December 2019, but data on clinical features and response to treatment among children has been scarce. The estimated incidence of enteric fever in Pakistan is 413 cases per 100,000 population among children ages 2 to 4, and 573 cases/100,000 population in children ages 5 to 15.

The median age of the patients was 5, and 57.5% were boys. Of the 270 patients with recorded outcomes, 234 (86.7%) were cured within 14 days, while a delayed response to antibiotics was noted in 32 (11.9%). Four children died. Seventy-six children (29%) recovered after treatment with a combination of meropenem and azithromycin, 72% were successfully treated with azithromycin alone, and 15 (6%) responded to meropenem alone.

The study authors note that literature from other parts of Pakistan has also reported a higher frequency of infection among children aged 5 years or younger, which could be explained by the fact that children have lower immunity and require lower bacterial doses to develop infection.

“This study confirms that XDR S. Typhi is common in children under 5 years of age,” they wrote. “We advocate increasing nationwide awareness about the consumption of safe water, antibiotic stewardship and immunisation practices of children.”
Sep 3 BMC Infect Dis study


Indian surveillance report highlights rising carbapenem resistance

The latest antimicrobial resistance (AMR) surveillance data from India shows an increase in carbapenem-resistant Enterobacterales and a rise in fungal infections among hospitalized patients.

The 2020 report from the Indian Council of Medical Research (ICMR) Antimicrobial Resistance Research and Surveillance Network shows that Escherichia coli was the most commonly isolated bacterial pathogen among 65,561 isolates collected from tertiary care hospitals, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus aureus

Among the E coli isolates, susceptibility to imipenem was 72%, down from 86% in 2016 but up from 63% in 2019. K pneumoniae susceptibility fell from 65% in 2016 to 45% in 2020. The authors of the report say the lower susceptibility to imipenem is reflective of the increase in carbapenem use in India over the past two decades.

The ICMR also reported reduced susceptibility in A baumannii and P aeruginosa. Among A baumannii isolates, reduced susceptibility of 10% to 20% was observed against carbapenems, cephalosporins, monobactams, and beta-lactam/beta-lactamase inhibitor combinations. Only 40% of P aeruginosa isolates were susceptible to fluoroquinolones, and 60% to 70% were susceptible to carbapenems, cephalosporins, and aminoglycosides.

Among the increasing number of fungal infections observed in Indian hospitals, the ICMR reported that the multidrug-resistant yeast Candida auris was consistently isolated from regional hospitals across India. Most C auris isolates were resistant to fluconazole, and the incidence of echinocandin resistance is on the rise.

“Systematic collection, evaluation, and analysis of resistance data of specific pathogens for [the] last five years have highlighted that certain pathogens have become highly drug resistant and have become clinicians’ dilemma,” the report noted. “Aggressive action for prevention, containment, and treatment are needed at the national level.”
Sep 2 ICMR surveillance report

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