The Antimicrobial Resistance in India

Subject: Healthcare Research
Pages: 6
Words: 1761
Reading time:
7 min
Study level: Bachelor

Introduction

Antibiotics have improved Health and saved the lives of countless people worldwide by allowing them to treat bacterial infections successfully. Several health organizations have identified antimicrobial resistance (AMR) as a global problem, and antibiotic-resistant organisms cause major sickness and mortality. Effective and novel medicines, as well as prevention efforts, are required as drug resistance emerges. This essay attempts to analyze and evaluate how vaccines can aid in the fight against AMR. The emergency spread of AMR and antibiotic use are reduced due to the usage of vaccines as a preventive measure. The paper will also explore prospective barriers to vaccine advance and discuss the influence of next-generation vaccination contrary to speculation and bacteria communicable disease on AMR in low-income and high-income countries.

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The Reported Rate of AMR in India: The Problem Statement

For AMR prevention, One Health concept emphasizes the interdependence of environmental, animal, and human variables. The same can be said for India, whose AMR rates have risen significantly in all three sectors over the last three decades (Gove & Hancock, 2019). Another problem is the absence of adequate data and research, which makes it difficult to estimate AMR’s precise increase and scope in India and precludes a nationwide comparison. Only 90 (4.2%) studies on the environment, 70 (3.3%) studies on animals, and 11 (0.5%) studies on One Health were among the 2152 studies on AMR published by Indian institutions (Taneja & Sharma, 2019, p. 120). The rest were based on new agents, diagnostics, editorials, and other miscellaneous information.

AMR in M an

According to the government of India scoping report on antimicrobial resistance in India (2017), more than 70% of isolates of Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli, as well as nearly half of all Pseudomonas aeruginosa, were resistant to third-generation cephalosporins and fluoroquinolones (Taneja & Sharma, 2019, p. 120). Although P. aeruginosa and E. coli remained resistant to the medication combination piperacillin-tazobactum in 35% of cases, the presence of several resistance genes, including carbapenems, made K. pneumoniae resistant in 65% of cases (Klugman & Black, 2018). The use of colistin as the last resort antibiotic became more common as carbapenem resistance rates increased by 71% in A. baumannii. India has also seen a rise in colistin resistance, even though the rate of colistin resistance was just 1%, except for the 4.1% that colistin-resistant K. pneumoniae was associated with high mortality of 70% (Davies et al., 2021, p. 10). Methicillin-resistant Staphylococcus aureus made up 42.6 percent of Gram-positive bacteria, whereas vancomycin-resistant Enterococcus faecium made up 10.5 percent (Taneja & Sharma, 2019, p. 120). Resistance to ciprofloxacin was found in 82 and 28 percent of Shigella and Salmonella Typhi species, respectively, co-trimoxazole resistance was 2.3 and 80%, and ceftriaxone resistance were 0.6 and 12%.

AMR in Food Animals

According to 2015 analysis, India was the world’s second greatest producer of fish and the world’s largest milk producer (Yilmaz & Schiffer, 2021). Furthermore, between 2000 and 2030, India’s poultry consumption is predicted to increase by 577% (Taneja & Sharma, 2019, p. 120). Antimicrobial drugs are being used in huge amounts to increase production in the food animal industry, which has a lot of promise. India produced 137,685.80 tonnes of milk in 2013-2014, with the states of Andhra Pradesh (9.4%), Rajasthan (10.6%), and Uttar Pradesh (10.6%) contributing the most (17.6%). When Gram-negative bacteria were identified in buffalo and cow milk to determine AMR in cattle, 48 percent produced extended-spectrum lactamases (ESBL), and 47.5 percent were oxytetracycline resistant. Gram-positive organisms collected from these milk samples contained S. aureus in 2.4 percent of the cases (Taneja & Sharma, 2019, p. 120). Vancomycin resistance was found in 21.4 % of S. aureus, while methicillin resistance was found in 21.4% (Taneja & Sharma, 2019, p. 120). Coagulase-negative Staphylococci accounted for 5.6% of the total. India, which produces 957910 tonnes of fish a year, is becoming a vital aquaculture center.

AMR in Environment

In some Indian water sources, antimicrobial-resistant genes and bacteria have been discovered. Pharmaceutical waste fluids and hospital effluents are two significant sources of pollution that are thrown into nearby bodies of water without being adequately treated (Micoli et al., 2021). The rates of separation of E. coli resistant to third-generation cephalosporin were 25, 70, and 95 percent, respectively, when the intake to the treatment plant was household water alone, domestic waste combined with hospital effluent, and hospital effluent alone (Taneja & Sharma, 2019, p. 121). India’s Yamuna and Ganges rivers span a huge land area and receive multiple inlets containing variable proportions of drug-resistant bacteria (Gove & Hancock, 2019). Resistance genes such as blaOXA48 and blaNDM-1 were discovered in 17.4 percent of Gram-negative bacteria isolated from these north Indian rivers (Taneja & Sharma, 2019, p. 121). In central India, E. coli resistant to third-generation cephalosporins was detected in 17 percent of surface and groundwater used for recreational and drinking purposes, compared to 100% in south India, 50% in east India, and 7% in north India (Davies et al., 2021, p. 7). The water samples used in this research came from tube wells, hand pumps, lakes, springs, ponds, and rivers.

Challenges of AMR in India

The world’s AMR capital has been described as India, whereby the introduction of additional multidrug-resistant (MDR) organisms presents new therapeutic and diagnostic problems. India is still fighting old enemies like cholera pathogens, tuberculosis, and malaria, becoming increasingly medication-resistant (Taneja & Sharma, 2019, p. 121). Factors such as ignorance, overcrowding, poverty, and starvation all contribute to the situation. The general public’s lack of information on infectious diseases and their lack of access to healthcare often prevents people from seeking medical advice. This usually leads to antimicrobial agent self-prescription in the absence of expert knowledge of treatment duration and dose. Many people are seeking medical advice end up using broad-spectrum high-end antimicrobials due to a lack of adequate diagnostic procedures for identifying the infection and its treatment susceptibility. Low nurse-to-patient and doctor-to-patient ratios, as well as a lack of infection prevention and control (IPC) measures, help MDR pathogens spread in hospital settings (Taneja & Sharma, 2019, p. 121). The broad availability of over-the-counter (OTC) drugs contributes to AMR.

The pharmaceutical industry’s expansion has coincided with a rise in the amount of waste produced by these enterprises. Due to a lack of robust legislation and administrative measures, this rubbish reaches water bodies and serves as a constant source of AMR in the environment. Another major issue could be using antimicrobials as pesticides and herbicides in agriculture, albeit there is currently no evidence for this. India’s agricultural areas are enormous, and farmers already confront numerous challenges from natural disasters, harsh weather, and challenging terrain (Taneja & Sharma, 2019, p. 121). They are influenced by the allure of using antimicrobial agents to safeguard their hard-won field from rodents and pests without reconsidering the long-term repercussions. This vast pool of antimicrobial compounds provides an ideal environment for MDR infections to evolve, which subsequently drift into water bodies during floods and rainstorms (Taneja & Sharma, 2019, p. 121). The lack of data on the scope of AMR, particularly in the environment and animals, makes it challenging to implement and create policies to combat the disease.

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Drivers of Environmental AMR in India

Excess Use or Misuse of Antimicrobial Agents

Antimicrobial resistance is exacerbated by human antimicrobial use: India consumes the most antibiotics for human use of any country on the planet. Antibiotics were consumed in India at a rate of 12.9 10 units per person in 2010. Antibiotic retail sales increased by 23% between 2000 and 2010 (Taneja & Sharma, 2019, p. 122). Since then, it is expected that the pace of consumption has risen. While medical practitioners were found to lack adequate information about the sensible use of antibiotics, especially fixed-drug combinations, the widespread availability of illegal antimicrobials demonstrates a deficiency in health authorities’ efforts. According to research, India is the world’s biggest producer and user of counterfeit and substandard antimicrobial agents, with up to 39% of those tested being found to be illiterate (Taneja & Sharma, 2019, p. 122). Nearly half of the antibiotic eaten is excreted in the urine and feces unaltered. Defecating in the open, which has been practiced in India for decades, results in antibiotics or antibiotic residues seeping into the atmosphere via water and soil.

AMR Contributed by Antimicrobial Use in Animals

India is a major producer of meat products and farmed fish for the global market, and this industry is expected to grow by 312 percent by 2030. (Taneja & Sharma, 2019, p. 122). Antimicrobial medicines are routinely utilized in these farmed animals to prevent sickness and boost productivity. After the United States, China, and Brazil, India is the world’s fourth-largest consumer of antimicrobials for animal usage. According to analysis (Taneja & Sharma, 2019, p. 122), India will provide the biggest relative rise in antimicrobial use in cattle between 2010 and 2030 if current trends continue.

Contaminated Water as a Source of AMR

India is one of the world’s largest producers of pharmaceuticals. Ciprofloxacin levels in the wastewater of one of the Indian pharmaceutical firms were 31 and 28 mg/l on two consecutive days. Many kilograms of antibiotics are released into the wastewater each day when these values are extended to the whole amount of effluent produced (Taneja & Sharma, 2019, p. 122). Antimicrobial categories like sulphonamides and fluoroquinolones leave stable residues in the environment, whereas beta-lactam medicines break down more quickly. Municipal wastewater becomes an essential dumping ground for resistant genes or organisms because 30-90% of all antimicrobials are discharged intact via human urine and feces (Klugman & Black, 2018). Only 20-30% of municipal wastewater is treated at treatment plants, insufficient to eradicate resistant bacteria. Healthcare institutions are significant contributors to antimicrobial waste, either directly through indirectly through patient secretions or indirectly through unused and discarded medications.

Conclusion

Despite ample evidence that vaccinations have a high potential for lowering AMR and rising evidence supporting the effectiveness of existing vaccines in preventing the spread and emergence of AMR, it is difficult to predict the possible impact of vaccines currently being developed. This is due to the difficulty in identifying all of the factors contributing to the spread of AMR. and the fragmented and difficult-to-retrieve data on antibiotic use for diverse diseases. As a result, new and more sophisticated cost-effectiveness measurement methods must be developed. In India, AMR in the environment has been mostly ignored. With the ever-increasing threat of AMR in India’s environment, immediate action is required to limit its spread and advancement. In contrast, a comprehensive and multisectoral approach is needed, as well as coordinated efforts and monitoring.

References

Davies, N. G., Flasche, S., Jit, M., & Atkins, K. E. (2021). Modeling the effect of vaccination on selection for antibiotic resistance in Streptococcus pneumoniae. Science Translational Medicine.

Gove, M., & Hancock, M. (2019). Tackling antimicrobial resistance 2019–2024. The UK’s five-year national action plan.

Klugman, K. P., & Black, S. (2018). Impact of existing vaccines in reducing antibiotic resistance: Primary and secondary effects. PNAS, 115(51). 12896-12901.

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Micoli, F., Bagnoli, F., Rappuoli, R., & Serruto, D. (2021). The role of vaccines in combatting antimicrobial resistance. Nature Reviews Microbiology, 19, 287–302.

Taneja, N., & Sharma, M. (2019). Antimicrobial resistance in the environment: The Indian scenario. Indian Journal of Medical Research, 149(2). 119–128.

Yilmaz, N. K., & Schiffer, C. A. (2021). Introduction: Drug resistance. Chemical Reviews, 121(6), 3235-3237.