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Distribution between community-acquired and hospital-acquired infections getting blurred; misuse of antibiotics partly the reason
Drug-resistant strains that have a high mortality rate-cases of which were usually seen among people that had recently been to a hospital – are now spreading to people who have had no contact with any healthcare centre for over three months, a recent study has revealed.
Conducted by researchers from the Department of Critical Care, Sir Ganga Ram Hospital, and its affiliated City hospital on 201 patients of Community-Acquired Infections, the study has been accepted for publication in Journal of Critical Care.
Dr. Sumit Ray, author of the study and vice-chairman of the Department of Critical Care, Sir Ganga Ram Hospital said: “The distinction between community-acquired and hospital-acquired infections is becoming increasingly blurred. The main reasons for this are spread of classically ‘hospital’ strains, particularly resistant Klebseilla and E. Coli, into the community and vice versa, and the repeated admission of individuals to hospitals with long-standing underlying diseases.
Building resistance
“In addition, the contribution of antibiotic resistance to the community through easily available antibiotics often used without medical supervision has resulted in an increasing reservoir of potential infections,” said Dr. Ray.
He added that resistance to high-end antibiotics by patients in the community “is a cause for worry and needs further research and proper action plan”.
Infections due to multidrug resistant organisms have become a serious health concern worldwide. The study – association of high mortality with extended-spectrum Beta-lactamase (ESBL) positive culture in community acquired infections – was conducted to investigate the spectrum of microbial resistance pattern effects of mortality. The study notes that infections due to multi-drug resistant organisms, particularly those producing extended-spectrum Beta-lactamases, are of majority concern worldwide.
New generation ESBLs are organisms that are resistant to various newer-generation antibiotics and can be easily transferred to the community. These resistant infections pose therapeutic challenges to clinicians in the treatment of these patients and may therefore be associated with high morbidity and mortality.
“The striking point noted in our results is the emergence of E. coli as most common bacteria in the community causing bacteramia, respiratory and urinary tract infection and higher mortality in ESBL positive producers as compared to ESBL negative producers,” said Dr. Ray. Among the 201 patients studied, 63.44% who contracted E. coli were ESBL producers.
Trickling into the society
This reflects the increased resistance pattern to high-end antibiotics in Hospital-Acquired Infections due to inadvertent early use of third-generation Bera-lactam antibiotics, such as cephalosporins, which is further trickling over into the community because of “plasmid mediated during its genetic materials during conjugation”, noted the study. Dr. Debashish Dhar, consultant at the Department of Critical Care, City Hospital, who was part of the research team and co-author of the predominant pathogens isolated from community-acquired infections were E. coli (46.2%) followed by Klebsiella pneumonia (13.9%) and S. aureus (13.9%)”.