‘Drug of last resort’-Carbapenem losing out to pathogens

India is witnessing an alarming rise in the rate of carbapenem-resistant bacteria underlining the need for enhanced antimicrobial surveillance and prevention of antibiotic misuse. Carbapenem-resistant pathogens are a major public health challenge as carbapenems are the last line of treatment for patients with serious infections.

What is AMR?
Antimicrobial resistance (AMR) is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others.

AMR status report:
In its first country report submitted to WHO’s Global Antimicrobial Resistance Surveillance System (GLASS), a platform for global action against antimicrobial resistance (AMR), India has acknowledged the growth of carbapenem-resistant strains in tertiary care settings at home. GLASS was set up in 2015 but India has sent its AMR status to WHO for the first time this year. Another concern ICMR has recorded in the report is increasing resistance of bacteria to new line of antibiotics like Linexolid, Tigecycline and Vaxomycin — all used to treat serious bacterial infections.

Carbapenems:
Carbapenems are often considered to have the broadest spectrum of activity among all antibiotic classes.Closely related to penicillins, carbapenems are bactericidal beta-lactam antibiotics that bind to penicillin-binding proteins (PBPs). By binding and inactivating these proteins, carbapenems inhibit the synthesis of the bacterial cell wall, which leads to cell death.

Problem area:
Carbapenem resistance is increasing every year at a very high rate of five to 10 per cent. Overall, the rate of antibiotic resistance to carbapenems in Indian tertiary care settings is anywhere between 50 to 70 per cent. Growing carbapenem resistance means increasing inability of the health systems to fight serious and advanced urinary tract infections, lower respiratory tract and bloodstream infections.

Why carbapenems are called ‘drug of last resort’?
Carbapenems are described as “drugs of last resort” because they are the last line of treatment for penicillin-resistant infections where all other antibiotics have failed. The only antibiotic left to be administered after carbapenems is colistin which is not a very good drug as it causes high renal toxicity in patients and mandates regular monitoring of patients.

The solution:
Controlled use of antibiotics from primary to community to tertiary hospital settings

By: Dr. Vivek Rana