09 December 2011
By Umesh Isalkar
Antibiotics resistance is being studied at 14 state–run colleges attached hospitals to gauge the gravity of the issue, said microbiologist Neeta Jangle, officer on special duty (OSD), Directorate of Medical Education and Research (DMER).
The state-run 14 medical colleges attached hospitals – including the Sassoon Hospital in Pune – is part of the state-wide surveillance programme of anti–microbial resistance in hospitals.
"One of the biggest challenges is finding out the true size of the problem of antibiotics resistance. We need better data to work out an action plan," Jangle said.
Microbiologists have been emphasising the urgent need for microbiological laboratory support for doctors and strict guidelines on antibiotic prescriptions and policies for quite some time. Last year, a controversy blew up in the country about the highly resistant 'superbugs' bacteria containing the 'NDM–1' enzyme.
Anti–microbial resistance is the inevitable result of inappropriate use of antibiotics in hospitals and in the community (including subtherapeutic doses due to ignorance about resistance mechanisms), widespread over–the–counter sales of antibiotics and patients failing to complete their courses of antibiotics.
"This is the start of a process. We can and have to raise awareness among policy–makers and the public," Jangle said. Experts say that simply restricting over–the–counter sale of anti–microbials will not achieve much and suggest that more is needed to curb the use of second–line antibiotics, which should be used as a last resort and when the first–line antibiotics fail.
"The beneficial effect of restriction of first–line antibiotics sold over the counter will be evident in the long run, but what we need most is restriction of higher–end antibiotics used in hospitals," said senior microbiologist Renu Bharadwaj, head of the microbiology department of the Sassoon General Hospital.
Recently, the microbiology department of the Sassoon hospital collected blood and urine samples of 3,172 patients and found multidrug resistance in 66% people. Besides, 181 were found resistant to the highest level of antibiotics that is Carbapenems. The study also found that 20 people were carrying the NDM–1 bacteria. Of the total cases, 885 had gram negative bacteria and about a fifth of these were resistant to very high level of antibiotics. All Carbepenem–resistant isolates were sent to the National Centre for Cell Science (NCCS) for genetic sequencing to identify the NDM 1 gene.
A group of microbiologists from Pune and Hyderabad had also found an alarming level of drug–resistant E.coli bacteria with high virulence in people with urinary tract infection (UTI) living in a semi–urban, industrialised setting in Pimpri Chinchwad a few months ago.
Urinary tract infections are the second most common type of infections and rise from Escherichia coli (E.coli), which normally thrives in the colon. Women are particularly susceptible to this infection which accounts for about 8.3 million doctor visits each year.Objective
The state–wide surveillance programme of anti–microbial resistance in hospitals is aimed at finding the true size of antibiotics resistance. As many as 14 state–run medical colleges attached hospitals including the Sassoon Hospital in Pune is part of the surveillance programme.Way Ahead
Knowledge of the resistance pattern will help correct and lead to judicious antibiotic use.