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5-Year Trends and Associations of Antimicrobial Resistance in Urinary Tract Infections in India (2017-2021): A Multi-Centric, Retrospective, Longitudinal Analysis

37 Pages Posted: 14 Jan 2023

See all articles by Jasmine Kaur

Jasmine Kaur

Indraprastha Institute of Information Technology - Department of Computational Biology; Indian Council of Medical Research (ICMR) - Division of Biomedical Informatics

Aditya Nagori

Indraprastha Institute of Information Technology - Department of Computational Biology

Balaji Veeraraghavan

Christian Medical College - Department of Clinical Microbiology

Vinod Ohri

Indian Council of Medical Research (ICMR) - Division of Epidemiology and Communicable Diseases

Rakesh Lodha

All India Institute of Medical Sciences (AIIMS) - Department of Pediatrics

ICMR-AMR Surveillance Network Collaborators

Independent

Kamini Walia

Indian Council of Medical Research (ICMR) - Division of Epidemiology and Communicable Diseases

Harpreet Singh

Indian Council of Medical Research (ICMR) - Division of Biomedical Informatics

Tavpritesh Sethi

Indraprastha Institute of Information Technology - Department of Computational Biology

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Abstract

Background: Urinary Tract Infections (UTIs) affect nearly 150 million people worldwide annually. High antimicrobial resistance (AMR) is reported in India. However, no studies provide multicentric, nationwide data on trends and associations of AMR in UTIs. To our knowledge, this study presents the most comprehensive estimates of trends and associations of AMR across India.

Methods: AMR surveillance data collected from 20 tertiary care centers across India by the Indian Council of Medical Research between 2017-2021 were analyzed for the four most prevalent uropathogens. Monthly AMR rates were decomposed to find linear trends, followed by lead/lag cross-correlation analyses for antibiotics and community/hospital-acquired UTIs (CA-UTI/HA-UTI). Associations between Sustainable development goals (SDG) indicators and AMR were discovered using a Bayesian network model.

Findings: For Klebsiella UTIs, we find a 0.27% (p<10-9) monthly increase in imipenem resistance. HA-UTI led CA-UTI in resistance to imipenem by 2-5 months, while CA-UTI led HA-UTI for resistance to ciprofloxacin (both p<0.05). For E. coli UTIs, monthly increase for imipenem (0.11%, p<0.05), nitrofurantoin (0.09%, p<10-22), piperacillin-tazobactam (0.18%, p<10-15), and levofloxacin (0.09%, p<10-6) resistance were seen. CA-UTI led HA-UTI by 2-8 months in ertapenem (p<0.05), amikacin (p<10-4), and cefazolin (p<0.001) resistance. HA-UTI led CA-UTI in nitrofurantoin, ciprofloxacin resistance (p<0.05). Amikacin resistance was a leading indicator for carbapenems in E. coli, Klebsiella species and P. aeruginosa (all p<0.05) in lead/lag analysis. Higher carbapenem resistance was associated with lower SDG3 achievement, most evidently in P. aeruginosa.

Discussion: The spatiotemporal trends, associations, and indicator drug patterns revealed in this study will be useful for designing agile surveillance and treatment policy guidelines across India. Interpretation Increasing carbapenem resistance had leading early warning signals which can be monitored for containment using data-driven treatment guidelines and antimicrobial stewardship.

Funding Information: No funding was received by any organization specifically for this analysis.

Declaration of Interests: The authors declare that they have no competing interests.

Ethics Approval Statement: All IAMRSN clinical sites obtained ethics approvals for the collection of the AMST data with a waiver of informed consent as (i) no patient was sampled exclusively for project work; (ii) all samples were collected as part of the standard of care for patient management; and (iii) the data were utilized maintaining full confidentiality after removing all the patient identifiers. Ethics approval for analysis of de-identified retrospective data was obtained at IIIT-Delhi. Institutional Ethics Committees of: Indraprastha Institute of Information Technology, Delhi All India Institute of Medical Science, Bhopal Assam Medical College, Dibrugarh Lokmanya Tilak Municipal Medical College and Hospital, Mumbai (LTMMC & LTMGH) Nizam Institute of Medical Sciences, Hyderabad Kasturba Medical College, Manipal Institute of Postgraduate Medical Education and Research, Kolkata King George’s Medical University, Lucknow Sher-i-Kashmir Institue of Medical Sciences, Srinagar All India Institute of Medical Science, Jodhpur All India Institute of Medical Science, New Delhi Christian Medical College, Vellore Jawaharlal Institue of Postgraduate Medical Education and Research, Pondicherry Sir Ganga Ram Hospital, Delhi Armed Forces Medical College, Pune P.D. Hinduja National Hospital and Medical Research Center, Mumbai Mahatama Gandhi Institue of Medical Sciences, Sevagram Tata Medical Center, Kolkata Apollo Hospital, Chennai Regional Institute of Medical Sciences Hospital, Imphal Postgraduate Institue of Medical Education and Research, Chandigarh.

Keywords: UTIs, AMR, Carbapenems, Antibiotic cross-correlation, Antibiotic clusters

Suggested Citation

Kaur, Jasmine and Nagori, Aditya and Veeraraghavan, Balaji and Ohri, Vinod and Lodha, Rakesh and Collaborators, ICMR-AMR Surveillance Network and Walia, Kamini and Singh, Harpreet and Sethi, Tavpritesh, 5-Year Trends and Associations of Antimicrobial Resistance in Urinary Tract Infections in India (2017-2021): A Multi-Centric, Retrospective, Longitudinal Analysis. Available at SSRN: https://ssrn.com/abstract=4316853 or http://dx.doi.org/10.2139/ssrn.4316853

Jasmine Kaur

Indraprastha Institute of Information Technology - Department of Computational Biology ( email )

Indian Council of Medical Research (ICMR) - Division of Biomedical Informatics ( email )

Aditya Nagori

Indraprastha Institute of Information Technology - Department of Computational Biology ( email )

Balaji Veeraraghavan

Christian Medical College - Department of Clinical Microbiology ( email )

Vinod Ohri

Indian Council of Medical Research (ICMR) - Division of Epidemiology and Communicable Diseases ( email )

Rakesh Lodha

All India Institute of Medical Sciences (AIIMS) - Department of Pediatrics ( email )

Kamini Walia

Indian Council of Medical Research (ICMR) - Division of Epidemiology and Communicable Diseases ( email )

Harpreet Singh

Indian Council of Medical Research (ICMR) - Division of Biomedical Informatics ( email )

Tavpritesh Sethi (Contact Author)

Indraprastha Institute of Information Technology - Department of Computational Biology ( email )

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