Emergence and control of multidrug resistant organisms in small cities in India: A wake up call.

Context: Urinary tract infections (UTIs) is one of the most common bacterial infections in general practice. Antimicrobial resistance in urinary pathogens, particularly the most common being Escherichia coli, is directly associated with prescribing in primary care. Diagnosis of UTI requires laboratory examination of urine sample in addition to clinical evaluation, which may lead to higher cost of treatment, but the proper treatment of the case that will lead to complete recovery with no recurrence episodes far outweigh the cost issue of microbiological investigation. Even though UTIs are a very common diagnosis, management of this condition is not consistent in general practice. This study was conducted in an effort to see the extent of presence of multi drug resistant organisms in local set up . Aims: To describe the common urine isolates observed in the small cities of India and also to test for drug resistance among them with simple manageable tests in small-scale laboratories. Materials and Methods: A retrospective review was conducted of Gram negative bacilli and Gram positive cocci isolated from the clinical urine samples collected from various hospitals and private practitioners in Shimoga City, Karnataka and Jamshedpur City, Jharkhand. The study period was between November 2011 to January 2012. Results: A total of 788 urine samples were included in the study. It was seen that 55.8% of the total isolated organisms were multidrug resistant (MDR) in Shimoga city, Karnataka and 38.8% of the total isolated organisms were MDR in Jamshedpur city, Jharkhand. Conclusions: Only with the combined efforts of the local laboratories and clinicians, the looming threat of the pandrug resistant organisms in small cities can be avoided. However, more such studies are required from both clinicians and laboratory health care professionals in order to arrive at a common consensus, and uniformity can be brought about in the community regarding prescription practices.

Extended-spectrum beta-lactamases [ESBLs]: a global problem

Extended-spectrum beta-lactamases [ESBL[s]] constitute a growing class of plasmid-mediated beta-lactamases which confer resistance to broad spectrum beta-lactam antibiotics. They are commonly expressed by Enterobacteriaceae but the species of organisms producing these enzymes are increasing and this is a cause for great concern. The prevalence of ESBL - producing organisms is increasing worldwide and several outbreaks have been reported. Serious infections with these organisms are associated with high mortality rates as therapeutic options are limited. The emergence of ESBLs creates a real challenge for both clinical microbiology laboratories and clinicians because of their dynamic evolution and epidemiology, wide substrate specificity with its therapeutic implications, their significant diagnostic challenges and their prevention and infection control issues. The aim of this review is to increase awareness about this serious antibiotic resistance threat