title: Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008-2014.
abstract: OBJECTIVE
  There have been no long-term studies on trends in antibiotic resistance (ABR) on a national scale in India. Using a private laboratory network, the ABR patterns of organisms most commonly associated with bacteremia, obtained from patients across India between 2008 and 2014, were examined.
  
  
  METHODS
  A retrospective study of patient blood cultures collected over a 7-year period (January 1, 2008-December 31, 2014) was conducted. Data on the microorganism(s) identified and their antimicrobial susceptibility were obtained from SRL Diagnostics (Mumbai, India).
  
  
  RESULTS
  Of 135268 blood cultures, 18695 (14%) had at least one identified pathogen. In addition to continual high rates of methicillin-resistant Staphylococcus aureus (MRSA; approximately 44.2%), high resistance to nalidixic acid among Salmonella Typhi (98%) was observed, and carbapenem resistance increased in both Escherichia coli (7.8% to 11.5%; p=0.332) and Klebsiella pneumoniae (41.5% to 56.6%; p<0.001). Carbapenem resistance was also stable and high for both Acinetobacter species (approximately 69.6%) and Pseudomonas aeruginosa (approximately 49%). Resistance was also detected to colistin in the Gram-negatives and to vancomycin and linezolid in S. aureus.
  
  
  CONCLUSIONS
  Increasing resistance to antibiotics of last-resort, particularly among Gram-negatives, suggests an urgent need for new antibiotics and improved antimicrobial stewardship programs in India.
authors: Center for Disease Dynamics, Economics and Policy, New Delhi, India.
authors: Sumanth
authors: S
authors: Gandra
authors: Center for Disease Dynamics, Economics and Policy, New Delhi, India.
authors: Nestor
authors: N
authors: Mojica
authors: Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland, USA; Center for Disease Dynamics, Economics and Policy, 1400 Eye Street NW, Suite 500, Washington, DC, 20005, USA.
authors: Eili Y
authors: EY
authors: Klein
authors: Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland, USA.
authors: Ashvin
authors: A
authors: Ashok
authors: SRL Limited, Mumbai, India.
authors: Vidya
authors: V
authors: Nerurkar
authors: SRL Limited, Mumbai, India.
authors: Mamta
authors: M
authors: Kumari
authors: SRL Limited, Mumbai, India.
authors: Uma
authors: U
authors: Ramesh
authors: SRL Limited, Mumbai, India.
authors: Sunanda
authors: S
authors: Dey
authors: SRL Limited, Mumbai, India.
authors: Viral
authors: V
authors: Vadwai
authors: SRL Limited, Mumbai, India.
authors: Bibhu R
authors: BR
authors: Das
authors: Center for Disease Dynamics, Economics and Policy, New Delhi, India; Public Health Foundation of India, Gurgaon, India; Princeton Environmental Institute, Princeton, New Jersey, USA. Electronic address: ramanan@cddep.org.
authors: Ramanan
authors: R
authors: Laxminarayan
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology*; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D000071997:Blood Culture; D015780:Carbapenems / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Antibacterial agents; Antibiotic resistance; Blood culture isolates; India; Trends