A ten year analysis of multi-drug resistant blood stream infections caused by Escherichia coli & Klebsiella pneumoniae in a tertiary care hospital.

BACKGROUND & OBJECTIVES: Extensive use of antibiotics has added to the escalation of antibiotic resistance. This study was undertaken to evaluate the association, if any between antibiotic use and resistance in a hospital setting, and also detect the predominant mechanism of antibiotic resistance in Escherichia coli and Klebsiella pneumoniae over a period of 10 years. METHODS: In a retrospective study of 10 years, a total of 77,618 blood culture samples from 2000 to 2009 from indoor patients were screened and those yielding E. coli and K. pneumoniae were included in the study. Antibiotic susceptibility records as well as the percentage of ESBL producers were noted. A total of 423 isolates of 2009 were also screened for AmpC and carbapenemase production. Antibiotic consumption data of 10 years were analysed. RESULTS: ESBL producing E. coli increased from 40 per cent in 2002 to 61 per cent in 2009, similarly there was a significant (P<0.05) rise in resistance to cefotaxime (75 to 97%), piperacillin-tazobactum (55- 84%) and carbapenem (2.4-52%) in K. pneumoniae. A significant (P<0.05) association was observed between resistance and consumption of carbapenem and piperacillin and tazobactum consumption in K. pneumonia. INTERPRETATION & CONCLUSIONS: Our study demonstrated a rise in consumption and resistance to broad spectrum antimicrobial agents and also established an association between consumption and resistance to these antibiotics. Over a period of 10 years, the emergence of pan-resistance in K. pneumoniae could be due to the production of carbapenemases whereas ESBL production was the common mechanism of resistance in E. coli. This study warrants a directed effort towards continued surveillance and antibiotic stewardship to minimize selection pressure and spread.

Current status of newer antiinfectives.

In the era of multidrug resistance keen interest needs to be taken in developing newer antiinfective drugs and patents. We all are aware that not many such drugs are readily available and still less are in the pipeline, and thus, such patents are limited in number. This is an attempt to review some of the newer antiinfectives used as antibacterial, antifungal and antiparasitic agents. An attempt has been made here to review the lately added newer antiinfectives. However, there has not been much change in the antiparasitic drug development arena. But it is interesting to note that even much older antiparasitic formulations are still of much use and the reason for this is reviewed here. Among the antibacterial drugs ertapenem, gemifloxacin, tigecycline and daptamycin are discussed. Doripenem has not been included here, due to the paucity of randomized trials of the molecule; however, it appears to be a promising penem that is to get added to the list of available antibiotics. The antiparasitic and antifungal drugs have attracted major attention of the research scientists and clinicians because of the increasing incidence of parasitic and fungal infections in the immunocompromised patients, leading to added morbidity and mortality. In the present review, besides newer antibiotics, newer anti parasitic and antifungal drugs have also been discussed.