Regional variations in antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli in India: findings of a multicentric study highlighting the importance of local antibiograms

Rizvi, Meher, Malhotra, Shalini, Agarwal, Jyotsna, Siddiqui, Areena H., Devi, Sheela, Poojary, Aruna, Thakuria, Bhaskar, Princess, Isabella, Sami, Hiba, Gupta, Aarti, Sultan, Asfia, Jitendranath, Ashish, Mohan, Balvinder, Banashankari, G. S., Khan, Fatima, Kalita, Juri Bharat, Jain, Mannu, Singh, N. P., Gur, Renu, Mohapatra, Sarita, Farooq, Shaika, Purwar, Shashank, Jankhwala, Mohmed Soeb, Yamuna Devi, V. R., Masters, Ken, Goyal, Nisha, Sen, Manodeep, Al Zadjali, Razan, Jaju, Sanjay, R, Rugma, Meena, Suneeta, Dutta, Sudip, Langford, Bradley, Brown, Kevin A., Dougherty, Kaitlyn M., Kanungo, Reba, Al Jabri, Zaaima, Singh, Sanjeev, Singh, Sarman, Taneja, Neelam, St John, Keith H., Sardana, Raman, Kapoor, Pawan, Al Jardani, Amina, Soman, Rajeev, Balkhair, Abdullah and Livermore, David M. ORCID: (2024) Regional variations in antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli in India: findings of a multicentric study highlighting the importance of local antibiograms. IJID Regions, 11.

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Objectives: Evidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics ( is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of Escherichia coli from 22 Indian centers. Methods: These centers spanned 10 Indian states and three union territories. Antibiograms for urinary E. coli from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed. Results: Nationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum β-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices. Conclusions: Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.

Item Type: Article
Uncontrolled Keywords: antimicrobial resistance,community-acquired utis,escherichia coli,india,infectious diseases,epidemiology,public health, environmental and occupational health ,/dk/atira/pure/subjectarea/asjc/2700/2725
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
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Depositing User: LivePure Connector
Date Deposited: 02 May 2024 14:30
Last Modified: 28 May 2024 08:30
DOI: 10.1016/j.ijregi.2024.100370


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