CRITICALLY IMPORTANT ANTIMICROBIALS

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Context: The annual report released by the Antimicrobial Resistance Research and Surveillance Network of the Indian Council of Medical Research (ICMR) for 2022 provides a comprehensive overview of the current state of antimicrobial resistance (AMR) in India.

Key findings and implications of the report:

• The report is the sixth in a series and focuses on AMR in India. It analyzes data from 107,053 culture-positive isolates obtained from 21 tertiary care hospitals. These isolates were collected from various specimen types, including blood, urine, superficial and deep infections, sterile sites, cerebrospinal fluid (CSF), and faeces.
• Clinical Settings: The report differentiates between isolates from outpatient departments (OPD), general wards, and intensive care units (ICU). Interestingly, E. coli and K. pneumoniae isolates from out-patients showed higher susceptibility compared to those from in-patients. Additionally, isolates from general wards demonstrated higher susceptibility compared to those from ICUs.
• Food Animal Use: The report also references an earlier 2021 report by the Centre for Science and Environment, which highlighted the misuse of several critically important antimicrobials (CIA) in food-producing animals in India. This misuse included the use of CIAs in dairy, poultry, and aquaculture for both therapeutic and non-therapeutic purposes, contributing to the development of AMR.
• Global Antibiotic Pipeline: The report notes the weak and fragile global pipeline for new antibiotics. This underscores the urgency of responsible antibiotic use and conservation in both human and animal health settings.

The report highlights several key pathogens of concern:

• Escherichia coli: This bacterium, known for causing a wide range of infections, showed low susceptibility to many critically important antimicrobials (CIAs). Notably, it exhibited high resistance to antibiotics such as levofloxacin, ciprofloxacin, cefotaxime, ceftazidime, and piperacillin-tazobactam.
• Klebsiella pneumoniae: A common cause of hospital-acquired pneumonia, K. pneumoniae exhibited low susceptibility to antibiotics, including cefotaxime, ceftazidime, ciprofloxacin, and levofloxacin.
• Pseudomonas aeruginosa: Isolates of P. aeruginosa from ward and ICU settings were found to be multidrug-resistant, with low susceptibility to fluoroquinolones. A significant proportion of isolates were resistant to carbapenems, particularly in ICUs.
• Acinetobacter baumannii: This pathogen, responsible for various diseases, including pneumonia and bloodstream infections, showed high resistance to carbapenems and low susceptibility to CIAs like cefepime, ceftazidime, and amikacin.
• Staphylococcus aureus and MRSA: Methicillin-resistant S. aureus (MRSA) strains of Staphylococcus aureus exhibited low susceptibility to antibiotics such as erythromycin and ciprofloxacin. Susceptibility to these antibiotics decreased over a five-year trend analysis.
• Salmonella typhi: The primary strain responsible for typhoid fever in India showed a high resistance rate to fluoroquinolones, limiting treatment options.

Implications

• The findings of this report have significant implications for public health in India. Increasing resistance among common infection-causing pathogens to CIAs, especially cephalosporins, fluoroquinolones, and carbapenems, can severely limit treatment options for various diseases. It highlights the urgent need for the responsible use and conservation of CIAs and underscores the importance of addressing AMR as a global health priority.

Critically Important Antimicrobials ●Antimicrobial resistance (AMR) is a global health crisis driven by the overuse and misuse of antibiotics and other antimicrobial drugs. It poses a significant threat to public health, causing increased morbidity, mortality, and healthcare costs. To address this issue, the concept of "Critically Important Antimicrobials" (CIAs) has emerged as a critical component of the fight against AMR. ●CIAs are antimicrobial drugs that are vital for treating serious infections in humans and animals. They are often the last line of defence when other antibiotics fail. ●CIAs are not abundant, and their supply is limited. This scarcity underscores the need for responsible use. The misuse of CIAs can accelerate the development of antimicrobial resistance, making them less effective over time. ●The importance of CIAs lies in their role in preserving human and animal health. They are indispensable for treating complex infections, including those caused by multidrug-resistant pathogens. ●Preserving the effectiveness of CIAs is crucial to ensuring the availability of treatment options for life-threatening diseases.

Conclusion

• The ICMR's annual report on antimicrobial resistance paints a worrisome picture of the state of AMR in India. The data presented in the report emphasizes the critical importance of implementing effective strategies to combat AMR, including responsible antibiotic use, surveillance, and the development of new antibiotics to address the growing threat of drug-resistant infections.

Must Read Articles:

Antimicrobial Resistance: https://www.iasgyan.in/daily-current-affairs/antibiotics-resistance

Embracing A One Health Framework To Fight Antimicrobial Resistance: https://www.iasgyan.in/daily-current-affairs/embracing-a-one-health-framework-to-fight-antimicrobial-resistance

PRACTICE QUESTION Q. What are the key factors contributing to the emergence and spread of antimicrobial resistance, and what strategies can be implemented at a global level to mitigate its impact on public health and healthcare systems?