Trends in antimicrobial resistance amongst pathogens isolated from blood and cerebrospinal fluid cultures in Pakistan (2011-2015): A retrospective cross-sectional study.

Nida Javaid,Qamar Sultana,Sumanth Gandra,Shaper Mirza,Safee Ullah Chaudhary,Karam Rasool,Fayyaz Ahmad,Iddya Karunasagar

doi:10.1371/journal.pone.0250226

Abstract

While antimicrobial resistance (AMR) continues to be a major public health problem in Pakistan, data regarding trends of resistance among pathogenic bacteria remains scarce, with few studies presenting long-term trends in AMR. This study was therefore designed to analyze long-term AMR trends at a national level in Pakistan. We report here results of a comprehensive analysis of resistance, among pathogens isolated from blood and cerebrospinal fluid (CSF), between 2011 and 2015. Susceptibility data was obtained from a local laboratory with collection points all across Pakistan (Chughtai Laboratory). Resistance proportions to most commonly used antimicrobials were calculated for each pathogen over a period of five years. While Acinetobacter species demonstrated highest resistance rates to all tested antimicrobials, a sharp increase in carbapenem resistance was the most noticeable (50%-95%) between 2011–2015. Our results also highlight the presence of third and fourth generation cephalosporins resistance in Salmonella enterica serovar Typhi in Pakistan. Interestingly, where rise in AMR was being observed in some major invasive pathogens, decreasing resistance trends were observed in Staphylococcus aureus, against commonly used antimicrobials. Overall pathogens isolated from blood and CSF between 2011–2015, showed an increase in resistance towards commonly used antimicrobials.

Highlights

The use of broad-spectrum antimicrobials for treatment of invasive infections, defined as bloodstream and cerebrospinal fluid (CSF) infections, has resulted in an increase in antimicrobial resistance (AMR)
The present study examined AMR data from a large diagnostic lab to identify (i) pathogens that are most commonly isolated from blood and CSF cultures in Pakistan, (ii) the patterns of resistance amongst these pathogens, and (iii) their co-resistance trends
We wanted to profile the distribution of bacterial pathogens isolated from blood and CSF cultures over patients’ demographics, geographic location and year of isolation

Summary

Introduction

The use of broad-spectrum antimicrobials for treatment of invasive infections, defined as bloodstream and cerebrospinal fluid (CSF) infections, has resulted in an increase in antimicrobial resistance (AMR). The treatment of such infections is becoming increasingly difficult leading to treatment failures and increased mortality. Antimicrobial resistance in Pakistan awarded to Dr Shaper Mirza] and Ignite Funds [Grant: ICTRDF/TR&D/2014/33 awarded to Dr Safee Ullah Chaudhary]. The funders had no role in study design, data collection, data analysis, decision to publish or preparation of the manuscript

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Discussion

Conclusion