What was so far perceived to be primarily hospital acquired infections, the multi-drug resistant (MDR) bacteria are now found loose in community as well, researchers from Sir Ganga Ram Hospital and City Hospital, both Delhi based have found.
What is more alarming is that these MDR organisms are killing more people than those from the non-resistant one. This also signals wide misuse of anti-biotics, say the doctors who had analysed 201 patients with community-acquired infections for the study. They found their infections carry "classically hospital strains" which were drug resistant with high mortality.
These patients did not come in contact with any health facility in the last three months or more, according to the researchers whose study "Association of high mortality with extended-spectrum-lactamase (ESBl) positive cultures in community acquired infections," has been accepted for publication in Journal of Critical Care. ESBls are organisms resistant to various newer generation antibiotics and can be easily transferred in the community.
Dr Sumit Ray, author of the study and vice-chairman , Department of Critical Care of Sir Ganga Ram Hospital said," the distinction between community-acquired and hospital-acquired infections is becoming increasingly blurred. The main reasons for this are the spread of classically 'hospital' strains, particularly resistant Klebseilla and E. Coli, into the community and vice versa, and the repeated admissions of individuals to hospitals with long standing underlying diseases.
"In addition, the contribution of antibiotic resistance in the community through easily available antibiotics often used without medical supervision has resulted in an increasing reservoir of potential infections ."
The resistance to high-end antibiotics by organisms contracted by patients in the community resulting in high mortality, seen in our study, is a cause for worry and needs further research and proper action plan, Dr Ray added.
According to the researchers, the striking point noted in the results is the emergence of E.coli as most common bacteria in the community causing bacteraemia, respiratory and urinary tract infection. They are also causing higher mortality in ESBl positive producers as compared to ESBl negative producers. "A high percentage (63.44 per cent) of these E.coli was ESBl producers. This reflects the increased resistance pattern to high end antibiotics in hospital acquired infections due to inadvertent early use of third generation cephalosporins in the last decade, which is further trickling over into the community, because of plasmid-mediated transfer of its genetic materials during conjugation," the study added.
Dr Debashish Dhar, author and consultant, Department of Critical Care, City Hospital said, "In our study, the predominant pathogens isolated from community acquired infections were E.coli (46.2 per cent) followed by Klebsiella pneumonia (13.9 per cent) and S aureus (13.9 per cent)."