High Burden of Antimicrobial Resistance and Mortality Among Adults and Children With Community-Onset Bacterial Infections in India.
In India, antimicrobial consumption is high, yet systematically collected data on the epidemiology, risk factors, and outcomes of antimicrobial-resistant infections are limited.



A prospective study of adults and children hospitalized for acute febrile illness was conducted between August 2013 and December 2015. In-hospital outcomes were recorded, and logistic regression was performed to identify independent predictors of community-onset antimicrobial-resistant infections.



Among 1524 patients hospitalized with acute febrile illness, 133 isolates were found among 115 patients with community-onset infections; 66 isolates (50.0%) were multidrug resistant and, of 33 isolates tested for carbapenem susceptibility, 12 (36%) were resistant. Multidrug-resistant infections were associated with recent antecedent antibiotic use (adjusted odds ratio [aOR], 4.17; 95% confidence interval [CI], 1.19-19.7) and were independently associated with mortality (aOR, 6.06; 95% CI, 1.2-55.7).



We found a high burden of community-onset antimicrobial-resistant infection among patients with acute febrile illness in India. Multidrug-resistant infection was associated with prior antibiotic use and an increased risk of mortality.
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Vidya
V
Mave
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Ajay
A
Chandanwale
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Anju
A
Kagal
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Sandhya
S
Khadse
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Dileep
D
Kadam
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Renu
R
Bharadwaj
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Vaishali
V
Dohe
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Matthew L
ML
Robinson
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Aarti
A
Kinikar
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Samir
S
Joshi
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Priyanka
P
Raichur
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Katie
K
McIntire
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Savita
S
Kanade
Tulane University School of Medicine, New Orleans, Louisiana.
Jonathan
J
Sachs
Byramjee Jeejeebhoy Government Medical College, Pune, India.
Chhaya
C
Valvi
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Usha
U
Balasubramanian
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Vandana
V
Kulkarni
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Aaron M
AM
Milstone
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Ivan
I
Marbaniang
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jonathan
J
Zenilman
Johns Hopkins University School of Medicine, Baltimore, Maryland.|Byramjee Jeejeebhoy Government Medical College, Pune, India.
Amita
A
Gupta
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000378:metabolism / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007194:India; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D055815:Young Adult
D000900:Anti-Bacterial Agents
India.; antimicrobial resistance; clinical isolates; community onset