XDR UPEC Prevalence in India
The available evidence does not provide specific data on extensively drug-resistant (XDR) UPEC prevalence in India, but studies demonstrate alarmingly high rates of multidrug-resistant (MDR) and ESBL-producing UPEC, with 52.8-68% MDR prevalence and 44.8-52.8% ESBL production rates across different regions.
Current Resistance Landscape
The most recent multicentric study from 2022 examining community-acquired UTI across four geographical regions of India reveals critical resistance patterns 1:
- ESBL production among UPEC isolates reached 52.8% 1
- Carbapenem resistance was documented in 5.1% of UPEC isolates 1
- Overall MDR prevalence (resistant to ≥3 drug classes) ranged from 61-68% in both community and hospital settings 1
Regional Variations
Studies from different Indian regions show consistent patterns of high-level resistance 2, 1, 3:
- Eastern India (Kolkata): 92.5% of UPEC isolates were multidrug-resistant, with 45% being ESBL producers 2
- Nationwide community settings: 44.8% overall ESBL prevalence among all uropathogens, with UPEC showing the highest rates 1
- Semi-urban settings: 31.3% ESBL production, including O25b-ST131 clones associated with high virulence and resistance 4
Specific Resistance Patterns
The resistance profile demonstrates near-universal failure of first-line agents 2, 1:
- Beta-lactams: 92.5-97.5% resistance to ampicillin/amoxicillin 2
- Fluoroquinolones: 80% resistance to ciprofloxacin 2
- Cephalosporins: >50% resistance to first- and second-generation agents 1
- Co-trimoxazole: 82.5% resistance 2
Preserved Susceptibility
Only limited agents maintain reasonable activity 1:
- Fosfomycin: 0% resistance among UPEC isolates 1
- Nitrofurantoin: 14-28% resistance 2, 1
- Amikacin: 30% resistance 2
Important Caveats
The distinction between MDR and XDR is critical but not explicitly reported in Indian studies 3. While XDR is defined as resistance to all but 1-2 antimicrobial categories, the available literature focuses on MDR (≥3 classes) and ESBL phenotypes rather than true XDR prevalence 1, 3.
The 5.1% carbapenem resistance rate in community UPEC is particularly concerning, as this represents potential progression toward XDR patterns 1. The presence of metallo-β-lactamases and AmpC producers further compounds the resistance burden 3.
The rapid emergence of antibiotic-resistant UPEC over the last six years (2015-2020) demonstrates an increasing national trend across all major antibiotic classes, suggesting the XDR problem may be evolving but remains inadequately characterized 3.