Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
Klebsiella Pneumoniae Community Acquired UTI: A Multicentric Study Highlights Significant Regional Variations in Antimicrobial Susceptibility Across India
Background: Knowledge of local antibiotic susceptibility rates is essential for strengthening antimicrobial stewardship programmes. DASH to Protect Antibiotics (https://dashuti.com/) is promoting the dissemination of focused local antibiograms in community UTI. This study maps the susceptibility profile of Klebsiella pneumoniae from eighteen Indian centres.
Methods: The centres spanned 9 Indian States and three Union Territories. Antibiograms for urinary K. pneumoniae from the outpatient were collated and analysed. Standardisation was achieved by online trainings. For epidemiological purposes five centres tested fosfomycin.
Results: Overall low susceptibility (< 60%) was observed to the standard oral antibiotics prescribed for cystitis. Cotrimoxazole susceptibility 54% (36-68%) was higher than that of ciprofloxacin 52% (29-55%), amoxicillin clavulanic acid 46%, (35-82%), nitrofurantoin, 39% (19-78%), and cefuroxime, 30% (15-62%). Rates for third- and fourth- generation cephalosporins were 49% (45-52%) and 60% (36-76%) respectively. ESBLs ranged from 36% in W. India to 61% in N. India. Piperacillin-tazobactam 74% (65-87%) amikacin 76%(45-91%), meropenem 81% (61-87%) exhibited higher activity. Fosfomycin was the most active antimicrobial, with 89% (92- 97%) susceptibility. K. pneumoniae susceptibility was directly linked to the geographic regions, log GDP (p < 0.001), humidity, low and high temperatures (p < 0.05).
Conclusions: A significant difference in antimicrobial susceptibility was observed between N. and S. India. Oral options for treating K. pneumoniae cystitis are rapidly diminishing. Empirically amoxicillin-clavulanic acid and cotrimoxazole would be better choices than fluoroquinolones and oral third generation cephalosporins. Piperacillin-tazobactam and aminoglycosides remain carbapenem-sparing agents. Improving socio-economic status should be a priority.
Funding: This study has no funding.
Declaration of Interest: There is no conflict of interest.
Ethical Approval: Ethical approval for the study was obtained by the centres.
Rizvi, Meher and Malhotra, Shalini and Sami, Hiba and Agarwal, Jyotsna and Siddiqui, Areena H. and Devi, Sheela and Poojary, Aruna and Thakuria, Bhaskar and Princess, Isabella and Gupta, Aarti and Malehi, Amal and Sultan, Asfia and Jitendranath, Ashish and Mohan, Balvinder and Khan, Fatima and El Tahir, Hatim and Ilanchezhiyan, N. and Jain, Mannu and Khan, Maria and Singh, N. P. and Gur, Renu and Mohapatra, Sarita and Farooq, Shaika and Devi, V.R Yamuna and Masters, Ken and Goyal, Nisha and Sen, Manodeep and Zadjali, Razan and R, Rugma and Meena, Suneeta and Datta, Sudip Kumar and Langford, Bradley and Kanungo, Reba and Jabri, Zaaima Al and Rajaibi, Arwa Al and Singh, Sajeev and Mamari, Azza AL and Singh, Sarman and St John, Keith H. and Sardana, Raman and Kapoor, Pawan and Al Jardani, Amina and Soman, Rajeev and Balkhair, Abdullah and Taneja, Neelam, Klebsiella Pneumoniae Community Acquired UTI: A Multicentric Study Highlights Significant Regional Variations in Antimicrobial Susceptibility Across India. Available at SSRN: https://ssrn.com/abstract=4996829 or http://dx.doi.org/10.2139/ssrn.4996829
Download This Paper