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 Gunjiganur Shankarappa, Khan Fatima, Kalita Juri Bharat, Jain Mannu, Singh Narendra Pal, Gur Renu, Mohapatra Sarita, Farooq Shaika, Purwar Shashank, Jankhwala Mohmed Soeb, Yamunadevi Vellore Ramanathan, Masters Ken, Goyal Nisha, Sen Manodeep, Zadjali Razan Al, Jaju Sanjay, Rugma Rajendradas, Meena Suneeta, Dutta Sudip, Langford Bradley, Brown Kevin A, Dougherty Kaitlyn M, Kanungo Reba, Jabri Zaaima Al, Singh Sanjeev, Singh Sarman, Taneja Neelam, John Keith H St, Sardana Raman, Kapoor Pawan, Jardani Amina Al, Soman Rajeev, Balkhair Abdullah, Livermore David M
Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
Department of Microbiology, ABVIMS and Dr RML Hospital, New Delhi, India.
IJID Reg. 2024 Apr 25;11:100370. doi: 10.1016/j.ijregi.2024.100370. eCollection 2024 Jun.
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 (https://dashuti.com/) 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 from 22 Indian centers.
These centers spanned 10 Indian states and three union territories. Antibiograms for urinary 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.
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.
Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated 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.
循证用药对于优化膀胱炎患者的治疗效果至关重要。这需要了解当地的抗生素耐药率。“保护抗生素的诊断与抗菌药物管理（DASH）”（https://dashuti.com/）是一项多中心指导项目，指导各中心编制、分析和传播当地的抗菌谱，以促进社区尿路感染中的抗菌药物管理。在此，我们绘制了来自印度22个中心的 的药敏谱。
这些中心分布在印度的10个邦和3个联邦属地。整理了门诊尿液的抗菌谱。通过区域在线培训实现标准化；通过与研究专家协商解决异常情况。对数据进行整理和分析。
在全国范围内，磷霉素的药敏率为94%（中心间范围为83 - 97%），呋喃妥因的药敏率为85%（61 - 97%），它们的抗菌活性范围最广。复方新诺明（49%）、氟喹诺酮类（31%）和口服头孢菌素（26%）的药敏率较低。第三代和第四代头孢菌素的药敏率分别为46%和52%，超广谱β-内酰胺酶的流行率为54%（33 - 58%）。哌拉西林 - 他唑巴坦（81%）、阿米卡星（88%）和美罗培南（88%）保持较好的活性；然而，德里的一个中心美罗培南的药敏率仅为42%。印度南部、西部和东北部的药敏率大多较高；印度北部和西北部人口密集的恒河平原地区的中心耐药性更强。这些发现凸显了当地抗菌谱在指导合理抗菌药物选择方面的重要性。
在印度，磷霉素和呋喃妥因是单纯性膀胱炎口服经验性用药的首选，尽管某些地区耐药性升高令人担忧。不鼓励经验性使用氟喹诺酮类和第三代头孢菌素，而哌拉西林/他唑巴坦和氨基糖苷类仍是可替代碳青霉烯类的肠外用药。
