Abstract
The emerging antimicrobial resistance leading to gram-positive infections (GPIs) is one of the major public health threats worldwide. GPIs caused by multidrug resistant bacteria can result in increased morbidity and mortality rates along with escalated treatment cost and hospitalisation stay. In India, GPIs, particularly methicillin-resistant Staphylococcus aureus (MRSA) prevalence among invasive S. aureus isolates, have been reported to increase exponentially from 29% in 2009 to 47% in 2014. Apart from MRSA, rising prevalence of vancomycin-resistant enterococci (VRE), which ranges from 1 to 9% in India, has raised concerns. Moreover, the overall mortality rate among patients with multidrug resistant GPIs in India is reported to be 10.8% and in ICU settings, the mortality rate is as high as 16%. Another challenge is the spectrum of adverse effects related to the safety and tolerability profile of the currently available drugs used against GPIs which further makes the management and treatment of these multidrug resistant organisms a complex task. Judicious prescription of antimicrobial agents, implementation of antibiotic stewardship programmes, and antibiotic policies in hospitals are essential to reduce the problem of drug-resistant infections in India. The most important step is development of newer antimicrobial agents with novel mechanisms of action and favourable pharmacokinetic profile. This review provides a synopsis about the current burden, treatment options, and the challenges faced by the clinicians in the management of GPIs such as MRSA, Quinolone-resistant Staphylococcus, VRE, and drug-resistant pneumococcus in India.
Highlights
Ever since the introduction of penicillin in 1940s, the fight against infections by gram positive bacteria has seen many ups and downs
Recent reports suggest that the prevalence of infections by multidrug resistant gram-positive bacteria is on the rise, with methicillinresistant Staphylococcus aureus (MRSA) among invasive S. aureus isolates estimated to be 29% in 2009, which increased to around 47% in 2014 [4]
The objective of this review is to provide an overview about the current burden of Gram-positive infections (GPIs), available treatment options, and challenges being faced by clinicians in managing GPIs in India
Summary
Ever since the introduction of penicillin in 1940s, the fight against infections by gram positive bacteria has seen many ups and downs. A direct consequence of this emergence of multidrug resistance (MDR) among gram-positive bacteria is the progressive depletion of effective antimicrobial agents to treat patients suffering from these infections. MDR leads to increased mortality and morbidity, ICU admissions, complications, requirement of therapy by multiple antimicrobial agents, and increased overall length of stay in the hospital All these factors result in an overall increase in the treatment cost, which can be disastrous in a country like India where most of the healthcare expenditure is borne out-of-pocket [8, 9]. A “resistant” bacterial strain is one whose in vitro growth is inhibited by an antibiotic in a concentration which, when used therapeutically, has a high likelihood of therapeutic failure; examples include MRSA, vancomycin-resistant S. aureus (VRSA), and vancomycinresistant enterococci (VRE) [10]
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