Chakraborty Debarghya, Roy Triparna, Gangopadhyay Priyankar
Internal Medicine, Princess Royal University Hospital, London, GBR.
Biostatistics and Health Informatics, King's College London, London, GBR.
Cureus. 2025 May 7;17(5):e83661. doi: 10.7759/cureus.83661. eCollection 2025 May.
Background Over the last 50 years, medical science has witnessed the emergence of antibacterial resistance at a concerning rate. Southeast Asia has become a leading epicenter for the development and spread of carbapenem-resistant bacterial strains. Socioeconomic background, being a major health determinant, can heavily affect this rate of antibiotic resistance. Methods This retrospective study was conducted at a 1,700-bed tertiary care facility in Kolkata, India, between October 2023 and January 2024. A total of 248 culture results from urine, sputum, blood, wound, and ascitic fluid, which showed growth of Gram-negative bacilli (GNB) and coccobacilli (GNCB) during the study period, were analyzed. Medical records were reviewed to collect demographic and clinical data. The comparison was made between two population groups based on economic status, identified by ration cards as defined by the Government of West Bengal, India. Results This study assessed the prevalence and antibiotic resistance patterns of Gram-negative bacteria in clinical samples, focusing on urine, blood, sputum, wound, and ascitic fluid. The analysis revealed that GNB were widely distributed across sample types, while GNCB showed higher prevalence in blood and ascitic fluid. Antibiotic resistance was notably prevalent among GNB, with 49 (27.5%) resistant to imipenem and 50 (28.1%) to meropenem. GNCB exhibited lower resistance, with six (14.3%) resistant to imipenem, eight (19.0%) to meropenem, and seven (16.7%) to doripenem. A comparison of carbapenem resistance (CR) between higher and lower socioeconomic classes showed no statistically significant differences, with resistance rates of 15 (41.7%) and 96 (45.3%), respectively. Further analysis of the most common isolates (, , , and ) also revealed no significant correlation between socioeconomic status and resistance, emphasizing that antibiotic resistance is a widespread issue transcending economic boundaries. Conclusion This study examines CR in Gram-negative bacteria across socioeconomic groups in Eastern India, finding no significant differences in resistance between higher and lower economic classes. Both groups showed similar levels of resistance, highlighting that antibiotic misuse, overprescription, and inadequate stewardship are pervasive issues transcending economic boundaries. The study emphasizes the need for enhanced healthcare provider training, public education on antibiotic misuse, and policy interventions to improve sanitation and waste management. Effective antibiotic stewardship and public health measures are crucial for combating resistance and ensuring equitable health outcomes.
背景 在过去50年里，医学见证了抗菌耐药性以令人担忧的速度出现。东南亚已成为耐碳青霉烯类细菌菌株产生和传播的主要中心。社会经济背景作为一个主要的健康决定因素，会严重影响抗生素耐药率。
方法 这项回顾性研究于2023年10月至2024年1月在印度加尔各答一家拥有1700张床位的三级医疗机构进行。对研究期间来自尿液、痰液、血液、伤口和腹水的248份培养结果进行了分析，这些结果显示有革兰氏阴性杆菌（GNB）和球杆菌（GNCB）生长。查阅医疗记录以收集人口统计学和临床数据。根据印度西孟加拉邦政府定义的配给卡确定经济状况，对两个人口群体进行比较。
结果 本研究评估了临床样本中革兰氏阴性菌的流行情况和抗生素耐药模式，重点关注尿液、血液、痰液、伤口和腹水。分析显示，GNB广泛分布于各种样本类型中，而GNCB在血液和腹水中的患病率较高。GNB中抗生素耐药现象尤为普遍，49株（27.5%）对亚胺培南耐药，50株（28.1%）对美罗培南耐药。GNCB的耐药性较低，6株（14.3%）对亚胺培南耐药，8株（19.0%）对美罗培南耐药，7株（16.7%）对多立培南耐药。对社会经济阶层较高和较低的人群之间的碳青霉烯类耐药性（CR）进行比较，结果显示无统计学显著差异，耐药率分别为15株（41.7%）和96株（45.3%）。对最常见分离株（ 、 、 和 ）的进一步分析也显示社会经济地位与耐药性之间无显著相关性，强调抗生素耐药是一个跨越经济界限的普遍问题。
结论 本研究调查了印度东部不同社会经济群体中革兰氏阴性菌的CR情况，发现社会经济阶层较高和较低的人群之间在耐药性方面无显著差异。两组的耐药水平相似，这突出表明抗生素滥用、过度处方和管理不善是跨越经济界限的普遍问题。该研究强调需要加强医护人员培训、开展关于抗生素滥用的公众教育以及采取政策干预措施以改善卫生和废物管理。有效的抗生素管理和公共卫生措施对于对抗耐药性和确保公平的健康结果至关重要。
