TY - UNPB
T1 - Antimicrobial Susceptibility Profile of Community-Acquired Uropathogenic Escherichia Coli Across India: A Multicentric Study Promoting Diagnostic Stewardship in the Management of UTI
AU - Rizvi, Meher
AU - Gupta, Aarti
AU - Sultan, Asfia
AU - Jitendranath, Ashish
AU - Mohan, Balvinder
AU - G.S, Banashankari
AU - Khan, Fatima
AU - Kalita, Juri Bharat
AU - Jain, Mannu
AU - Singh, N. P.
AU - Gur, Renu
AU - Malhotra, Shalini
AU - Mohapatra, Sarita
AU - Farooq, Shaika
AU - Purwar, Shashank
AU - Jankhwala, Mohmed Soeb
AU - Devi, V.R Yamuna
AU - Masters, Ken
AU - Goyal, Nisha
AU - Sen, Manodeep
AU - Zadjali, Razan
AU - R, Rugma
AU - Agarwal, Jyotsna
AU - Meena, Suneeta
AU - Dutta, Sudip
AU - Jabri, Zaaima AL
AU - Singh, Sarman
AU - Singh, Sarman
AU - Taneja, Neelam
AU - Sardana, Raman
AU - Kanungo, Reba
AU - Kapoor, Pawan
AU - Langford, Bradley
AU - Siddiqui, Areena H.
AU - Al Jardani, Amina
AU - Balkhair, Abdullah
AU - Soman, Rajeev
AU - Livermore, David M.
AU - Devi, Sheela
AU - Poojary, Aruna
AU - Thakuria, Bhaskar
AU - Princess, Isabella
AU - Sami, Hiba
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Introduction: Evidence-based prescribing in cystitis requires knowledge of local antibiotic resistance rates; national guidelines may not be representative across a country as large and complex as India. Accordingly, DASH to Protect Antibiotics is a multicentric mentorship programme guiding Indian centres in preparing, analysing and disseminating their own antibiograms to promote stewardship in community UTI. Material and Methods: Twenty-two centres were recruited, spanning 10 Indian States and three Union Territories. Using local antimicrobial susceptibility results, these assembled antibiograms for urinary Escherichia coli from the outpatient departments they served. Standardisation was carried out by region-wide online sessions; anomalies were resolved after consultation with the study experts and patron. Data were collated and analysed. Results: Nationally, fosfomycin (94% susceptibility, range: 83-97%) and nitrofurantoin (85%, range: 61-97%) retained the widest activity. Susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%) and oral cephalosporins (26%). Susceptibility rates for third- and fourth- generation cephalosporins were 46% and 52%, respectively, according with ESBL prevalence of 54% (33%-58%). Piperacillin-tazobactam (81%) amikacin (88%), meropenem (88%) retained better activity, but one centre in recorded only 42% meropenem susceptibility. Higher susceptibility rates were seen in South, West and Northeast India, whereas centres in the heavily-populated Gangetic plains, across North and Northwest India, reported greater resistance. Conclusions: Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, though locally-elevated resistance is concerning and will exert constrains. Piperacillin-tazobactam and aminoglycosides remain the best carbapenem-sparing agents if ascending infection precludes use of fosfomycin and nitrofurantoin.
AB - Introduction: Evidence-based prescribing in cystitis requires knowledge of local antibiotic resistance rates; national guidelines may not be representative across a country as large and complex as India. Accordingly, DASH to Protect Antibiotics is a multicentric mentorship programme guiding Indian centres in preparing, analysing and disseminating their own antibiograms to promote stewardship in community UTI. Material and Methods: Twenty-two centres were recruited, spanning 10 Indian States and three Union Territories. Using local antimicrobial susceptibility results, these assembled antibiograms for urinary Escherichia coli from the outpatient departments they served. Standardisation was carried out by region-wide online sessions; anomalies were resolved after consultation with the study experts and patron. Data were collated and analysed. Results: Nationally, fosfomycin (94% susceptibility, range: 83-97%) and nitrofurantoin (85%, range: 61-97%) retained the widest activity. Susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%) and oral cephalosporins (26%). Susceptibility rates for third- and fourth- generation cephalosporins were 46% and 52%, respectively, according with ESBL prevalence of 54% (33%-58%). Piperacillin-tazobactam (81%) amikacin (88%), meropenem (88%) retained better activity, but one centre in recorded only 42% meropenem susceptibility. Higher susceptibility rates were seen in South, West and Northeast India, whereas centres in the heavily-populated Gangetic plains, across North and Northwest India, reported greater resistance. Conclusions: Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, though locally-elevated resistance is concerning and will exert constrains. Piperacillin-tazobactam and aminoglycosides remain the best carbapenem-sparing agents if ascending infection precludes use of fosfomycin and nitrofurantoin.
KW - Escherichia Coli
KW - Community-Acquired UTIs
KW - India
KW - Antimicrobial Resistance
U2 - 10.2139/ssrn.4598960
DO - 10.2139/ssrn.4598960
M3 - Preprint
T3 - TLRHSOUTHEASTASIA-D-23-00666
BT - Antimicrobial Susceptibility Profile of Community-Acquired Uropathogenic Escherichia Coli Across India: A Multicentric Study Promoting Diagnostic Stewardship in the Management of UTI
ER -