Experts call for diagnostic tests-based prescription drugs and a holistic framework for infection control
Sepsis deaths occur when one's immune system has a dangerous reaction to a bacterial infection and without treatment, can lead to organ failure.
When a 60-year-old patient
with leukaemia was admitted to the emergency department with high fever and low
blood pressure, he was immediately started on broad-spectrum antibiotics.
However, the drugs didn’t work, complicating his condition. A blood culture
later revealed a drug-resistant Klebsiella infection, which required a
combination of drugs to bring it under control.
“The
patient’s condition deteriorated because of antimicrobial resistance (AMR), a
condition where bacteria and parasites become resistant to medicines that were
previously effective against them,” said Dr Abdul Ghafur, infectious diseases
expert at Apollo Hospital, Chennai.
Overuse or wrongful use of
antibiotics is exacting a toll on the health of Indians, with a latest Lancet
study showing that 60 per cent of the 29.9 lakh sepsis deaths in the country in
2019 were caused by bacterial infection.
Of this, nearly 10.4 lakh
sepsis deaths (33.4 per cent) were linked to bacterial AMR that year, with 2.9
lakh sepsis deaths directly attributable to it. Sepsis deaths occur when one’s
immune system has a dangerous reaction to a bacterial infection and without
treatment, can lead to organ failure.
WHAT’S
THE STATUS OF ANTIMICROBIAL RESISTANCE (AMR)?
“AMR is the result of overuse of antibiotics earlier in the patient’s lifetime or wrongful use. With rising rates of drug-resistant bacteria in India, treatment options are becoming increasingly limited, posing a public health challenge,” said Dr Ghafur.
Already widely recognised
as a major global health challenge, AMR is anticipated to worsen in the coming
decades with Lancet predicting that more than 39 million people around the
world could die from antibiotic-resistant infections over the next 25 years.The
report, based on a new study by the Global Research on Antimicrobial Resistance
(GRAM) Project, is the first global analysis of antimicrobial resistance trends
over time.
“Understanding how trends
in AMR deaths have changed over time, and how they are likely to shift in
future, is vital to make informed decisions to help save lives,” said study
author Dr Mohsen Naghavi, Team Leader of the AMR Research Team at the Institute
of Health Metrics (IHME), University of Washington, USA.
Estimates for the study
came from 22 pathogens, 84 pathogen-drug combinations and 11 infectious
syndromes (including meningitis, bloodstream infections, and other infections)
among people of all ages in 204 countries and territories, including India.
WHY
IS THE STUDY RELEVANT FOR INDIA?
The three most common
resistant pathogens in India are e.coli, which can cause gut infections;
Klebsiella pneumoniae, which can cause pneumonia and urinary tract infections;
and Acinetobacter baumannii, which is mainly associated with hospital acquired
infections.
According to Dr Ghafur,
AMR happens because of indiscriminate use of antibiotics over the counter. Many
do not follow the prescribed dose as advised by the doctor, abandoning them
midway, or use them for similar symptoms that may arise later, ignoring the
doctor’s advisory. Lack of diagnostics at the local level to identify the
disease-causing bacteria means broad spectrum antibiotics are prescribed, which
do not target the specific bacteria.
“Rational antibiotic use
requires adequate laboratory infrastructure to guide decision-making, such as
determining whether antibiotics are necessary and identifying the appropriate
antibiotic when they are.
Unfortunately, access to
such diagnostic facilities is often limited, especially in resource-constrained
settings… Inadequate sanitation leads to the spread of infections, which in
turn drives the demand for antibiotics and contributes to resistance,” Dr
Ghafur said. In some industries, like aquaculture, antibiotics are used to save
on production losses, so they enter your system through food.
WHAT
ARE RESISTANT BUGS?
The Lancet study shows
that lower respiratory infections and related infections in the thorax
accounted for most cases of sepsis deaths in India – about 27 per cent of the
total.
Of the five lakh deaths
due to sepsis in children under five in 2019, 3.25 lakh children succumbed to
bacterial infection. The deadliest bacterial infection among children under
five was streptococcus pneumoniae.
Deaths due to
methicillin-resistant S. aureus (MRSA) increased the most globally, leading
directly to 130,000 deaths in 2021 – more than double the from 57,200 deaths in
1990. Among gram-negative bacteria – some of the most resistant to
antimicrobial drugs – resistance to carbapenems increased more than any other
type of antibiotic, from 127,000 in 1990 to 216,000 in 2021.
In India, the drug-bug
combination with the highest fatal risk was the aminopenicillin-resistant
E.coli. At least 6.8 lakh deaths were associated with six leading
drug-resistant pathogens.
“A robust and enforceable
framework for infection control, alongside mandatory public reporting of
healthcare-associated infections (HAIs) by all accredited hospitals, is crucial
for transparency and accountability. By doing so, we can monitor progress and
identify gaps in care delivery,” said Dr Ghafur, adding that investments in new
antibiotics and rapid point-of-care diagnostics are also essential to combat
sepsis and other life-threatening infections.
Dr Kamini Walia, programme
officer of AMR and senior scientist at the Indian Council of Medical Research
(ICMR), said the government is already investing in improving laboratory
infrastructure and now it is mandatory to provide culture facilities in
district hospitals.
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