Meher Rizvi , Shalini Malhotra , Jyotsna Agarwal , Areena H. Siddiqui , Sheela Devi , Aruna Poojary , Bhaskar Thakuria , Isabella Princess , Hiba Sami , Aarti Gupta , Asfia Sultan , Ashish Jitendranath , Balvinder Mohan , Gunjiganur Shankarappa Banashankari , Fatima Khan , Juri Bharat Kalita , Mannu Jain , Narendra Pal Singh , Renu Gur , Sarita Mohapatra , David M. Livermore
{"title":"印度社区获得性尿路致病性大肠埃希菌对抗菌药敏感性的地区差异：一项多中心研究的结果凸显了当地抗生素图谱的重要性","authors":"Meher Rizvi , Shalini Malhotra , Jyotsna Agarwal , Areena H. Siddiqui , Sheela Devi , Aruna Poojary , Bhaskar Thakuria , Isabella Princess , Hiba Sami , Aarti Gupta , Asfia Sultan , Ashish Jitendranath , Balvinder Mohan , Gunjiganur Shankarappa Banashankari , Fatima Khan , Juri Bharat Kalita , Mannu Jain , Narendra Pal Singh , Renu Gur , Sarita Mohapatra , David M. Livermore","doi":"10.1016/j.ijregi.2024.100370","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>Evidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics (<span>https://dashuti.com/</span><svg><path></path></svg>) is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of <em>Escherichia coli</em> from 22 Indian centers.</p></div><div><h3>Methods</h3><p>These centers spanned 10 Indian states and three union territories. Antibiograms for urinary <em>E. coli</em> from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed.</p></div><div><h3>Results</h3><p>Nationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum β-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices.</p></div><div><h3>Conclusions</h3><p>Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated <em>E. coli</em> cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.</p></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772707624000419/pdfft?md5=d408d56255d5a172acaf3623fde4ea00&pid=1-s2.0-S2772707624000419-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Regional variations in antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli in India: Findings of a multicentric study highlighting the importance of local antibiograms\",\"authors\":\"Meher Rizvi , Shalini Malhotra , Jyotsna Agarwal , Areena H. Siddiqui , Sheela Devi , Aruna Poojary , Bhaskar Thakuria , Isabella Princess , Hiba Sami , Aarti Gupta , Asfia Sultan , Ashish Jitendranath , Balvinder Mohan , Gunjiganur Shankarappa Banashankari , Fatima Khan , Juri Bharat Kalita , Mannu Jain , Narendra Pal Singh , Renu Gur , Sarita Mohapatra , David M. Livermore\",\"doi\":\"10.1016/j.ijregi.2024.100370\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>Evidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics (<span>https://dashuti.com/</span><svg><path></path></svg>) is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of <em>Escherichia coli</em> from 22 Indian centers.</p></div><div><h3>Methods</h3><p>These centers spanned 10 Indian states and three union territories. Antibiograms for urinary <em>E. coli</em> from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed.</p></div><div><h3>Results</h3><p>Nationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum β-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices.</p></div><div><h3>Conclusions</h3><p>Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated <em>E. coli</em> cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.</p></div>\",\"PeriodicalId\":73335,\"journal\":{\"name\":\"IJID regions\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-04-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2772707624000419/pdfft?md5=d408d56255d5a172acaf3623fde4ea00&pid=1-s2.0-S2772707624000419-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"IJID regions\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772707624000419\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"IJID regions","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772707624000419","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Regional variations in antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli in India: Findings of a multicentric study highlighting the importance of local antibiograms
Objectives
Evidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics (https://dashuti.com/) is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of Escherichia coli from 22 Indian centers.
Methods
These centers spanned 10 Indian states and three union territories. Antibiograms for urinary E. coli from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed.
Results
Nationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum β-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices.
Conclusions
Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.
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