From the Guidelines
OXA-48 and NDM-producing bacteria are a significant concern in India, with a high prevalence of carbapenem-resistant Enterobacteriaceae carrying these genes, and management should prioritize combination therapy with ceftazidime/avibactam plus aztreonam for NDM producers, as recommended by recent guidelines 1.
Prevalence of OXA-48 and NDM in India
The prevalence of OXA-48 and NDM-producing bacteria in India is a significant public health concern, with studies indicating that carbapenem-resistant Enterobacteriaceae carrying these genes are found in a substantial percentage of clinical isolates in Indian hospitals, with regional variations 1.
Management of OXA-48 and NDM-producing bacteria
Management of infections caused by these bacteria requires a multifaceted approach, including:
- Infection control measures, such as contact precautions, dedicated equipment, environmental cleaning, and active surveillance in healthcare settings
- Appropriate antimicrobial therapy, with combination therapy typically recommended
- For NDM producers, the combination of ceftazidime/avibactam plus aztreonam is recommended, based on recent observational studies showing improved outcomes compared to other treatment options 1
- For OXA-48 producers, ceftazidime/avibactam may be considered as a first-line treatment option, although the evidence is limited and the recommendation is conditional 1
Key Considerations
- The high prevalence of OXA-48 and NDM-producing bacteria in India is attributed to factors including antibiotic misuse, poor sanitation, and inadequate infection control practices
- Newer agents like meropenem-vaborbactam and imipenem-relebactam have limited activity against these enzymes, and their use should be guided by susceptibility testing and clinical experience
- Infection control measures are crucial to prevent the spread of these resistant bacteria in healthcare settings, and active surveillance is necessary to monitor their prevalence and inform treatment decisions 1
From the Research
Prevalence of OXA-48 and NDM in India
- The prevalence of OXA-48 and NDM producing bacteria in India is a growing concern, with studies indicating an increase in their prevalence in recent years 2, 3.
- A study conducted in a tertiary hospital in North India found that 29.23% of Pseudomonas aeruginosa and 18.8% of Acinetobacter baumannii isolates were resistant to carbapenems and harbored the blaNDM gene 3.
- However, there is limited data available on the prevalence of OXA-48 and NDM producing bacteria in India, and more studies are needed to understand the scope of the problem.
Management of OXA-48 and NDM Producing Bacteria
- The treatment of OXA-48 and NDM producing bacteria is challenging, and there is a need for effective antibiotic treatment strategies 2, 4.
- Ceftazidime-avibactam is considered a viable treatment option for OXA-48 producers, while aztreonam-avibactam may be effective against NDM producers 2.
- Colistin remains a second-line option for the treatment of OXA-48 producers, but its use is limited due to concerns about resistance and toxicity 2, 5.
- The use of combination therapies, such as meropenem-containing combinations, is not recommended for the treatment of OXA-48 and NDM producing bacteria due to limited evidence of their effectiveness 2, 4.
Antibiotic Resistance Patterns
- Studies have shown that OXA-48 and NDM producing bacteria exhibit high levels of resistance to various antibiotics, including carbapenems, cephalosporins, and fluoroquinolones 3, 5, 6.
- The resistance patterns of OXA-48 and NDM producing bacteria can vary depending on the specific variant and the location of the infection 3, 6.
- The development of new antibiotic treatment strategies and the optimization of existing ones are crucial to combat the growing problem of antibiotic resistance in OXA-48 and NDM producing bacteria 2, 4, 6.