TY - JOUR
T1 - High burden of antimicrobial resistance and mortality among adults and children with community-onset bacterial infections in India
AU - Mave, Vidya
AU - Chandanwale, Ajay
AU - Kagal, Anju
AU - Khadse, Sandhya
AU - Kadam, Dileep
AU - Bharadwaj, Renu
AU - Dohe, Vaishali
AU - Robinson, Matthew L.
AU - Kinikar, Aarti
AU - Joshi, Samir
AU - Raichur, Priyanka
AU - McIntire, Katie
AU - Kanade, Savita
AU - Sachs, Jonathan
AU - Valvi, Chhaya
AU - Balasubramanian, Usha
AU - Kulkarni, Vandana
AU - Milstone, Aaron M.
AU - Marbaniang, Ivan
AU - Zenilman, Jonathan
AU - Gupta, Amita
N1 - Funding Information:
Financial support. This work was supported by the Ujala Foundation, the Johns Hopkins Center for Innovative Medicine and the Sacharuna Foundation, the Gilead Foundation, the Wyncote Foundation, the National Institutes of Health (NIH) BWI HIV Clinical Trials Unit (grant U01 AI069497 to V. M., N. S., San. K., U. B., V. K., I. M., and A. G.), and the UJMT Fogarty Global Health Fellows Program (NIH research training grant R25 TW009340 to M. R. and J. S. and NIH training grant T32 AI007291 to M. R.).
Publisher Copyright:
© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2017/4/15
Y1 - 2017/4/15
N2 - Background. In India, antimicrobial consumption is high, yet systematically collected data on the epidemiology, risk factors, and outcomes of antimicrobial-resistant infections are limited. Methods. A prospective study of adults and children hospitalized for acute febrile illness was conducted between August 2013 and December 2015. In-hospital outcomes were recorded, and logistic regression was performed to identify independent predictors of community-onset antimicrobial-resistant infections. Results. Among 1524 patients hospitalized with acute febrile illness, 133 isolates were found among 115 patients with community-onset infections; 66 isolates (50.0%) were multidrug resistant and, of 33 isolates tested for carbapenem susceptibility, 12 (36%) were resistant. Multidrug-resistant infections were associated with recent antecedent antibiotic use (adjusted odds ratio [aOR], 4.17; 95% confidence interval [CI], 1.19–19.7) and were independently associated with mortality (aOR, 6.06; 95% CI, 1.2–55.7). Conclusion. We found a high burden of community-onset antimicrobial-resistant infection among patients with acute febrile illness in India. Multidrug-resistant infection was associated with prior antibiotic use and an increased risk of mortality.
AB - Background. In India, antimicrobial consumption is high, yet systematically collected data on the epidemiology, risk factors, and outcomes of antimicrobial-resistant infections are limited. Methods. A prospective study of adults and children hospitalized for acute febrile illness was conducted between August 2013 and December 2015. In-hospital outcomes were recorded, and logistic regression was performed to identify independent predictors of community-onset antimicrobial-resistant infections. Results. Among 1524 patients hospitalized with acute febrile illness, 133 isolates were found among 115 patients with community-onset infections; 66 isolates (50.0%) were multidrug resistant and, of 33 isolates tested for carbapenem susceptibility, 12 (36%) were resistant. Multidrug-resistant infections were associated with recent antecedent antibiotic use (adjusted odds ratio [aOR], 4.17; 95% confidence interval [CI], 1.19–19.7) and were independently associated with mortality (aOR, 6.06; 95% CI, 1.2–55.7). Conclusion. We found a high burden of community-onset antimicrobial-resistant infection among patients with acute febrile illness in India. Multidrug-resistant infection was associated with prior antibiotic use and an increased risk of mortality.
KW - Antimicrobial resistance
KW - Clinical isolates
KW - Community onset
KW - India
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U2 - 10.1093/infdis/jix114
DO - 10.1093/infdis/jix114
M3 - Article
C2 - 28329303
AN - SCOPUS:85026695320
SN - 0022-1899
VL - 215
SP - 1312
EP - 1320
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 8
ER -