An observational study to understand antimicrobial sensitivity patterns in Maharashtra (India) based on lab data

Abstract

Background: Antimicrobial resistance (AMR) in India is becoming a public health problem of paramount importance. A significant part of the problem is preventable by streamlining and regularizing use of antimicrobials. THB, along with several healthcare providers like diagnostic labs and hospitals established a real-time surveillance system by using lab data and applying big data analytics. Objectives of the study - 1)To understand trends and patterns of AMR in the community, by using outpatient data from diagnostic labs in Maharashtra. 2)Analyse distribution of microorganisms by using outpatient data from diagnostic labs in Maharashtra. Methods & Materials: A sample of 20,616 including urine, pus, and sputum culture tests done between January 2016 and September 2017 were analysed. The sensitivity of isolated microorganisms has been analysed with respect to seven antimicrobial agents including Amoxiclav, Ceftriaxone, Cefuroxime, Cefixime, Cefpodoxime, Azithromycin and Levofloxacin. The analysis was conducted by maintaining patient confidentiality, by de-identifying all the personal information, in-line with the EMR standards of India. Results: Out of the total sample, 9,805 (47.6%) samples were positive for any type of bacterial or fungal growth. Pus showed the highest positivity (67.5%), followed by sputum (50.1%), and urine (45.8%). Among all cultures (sputum, pus, urine), five microorganisms constitute more than 87% share. These are E. coli (57.7%), Klebsiella (14.2%), Pseudomonas (8.4%), staphylococcus aureus and other species of staphylococcus (4.9%) and MRSA (1.9%). Overall, geriatric population demonstrated a higher percentage of pseudomonas in comparison to adult population. Isolates from geriatric population have shown the highest sensitivity to Cefpodoxime (55.7%), followed by Amoxiclav (42.2%). Paediatric population has shown highest sensitivity to amoxiclav, followed by levofloxacin. Among adults, isolates were most sensitive to cefpodoxime followed by amoxiclav and levofloxacin. The most common isolate among male and females is found to be E. coli, percentage isolation of E. coli was very high among females (63.4% vs. 44.9% in males). Isolates from females show higher sensitivity for most of the antimicrobial agents. Conclusion: A lab based surveillance system for monitoring patterns of antimicrobial resistance can be the key of success for any preventive strategy.