Kerala has published its antibiogram for 2023, marking the third consecutive year of monitoring antimicrobial resistance (AMR). This report puts stress on the state’s dedication to combatting a growing public health threat. The Kerala Antimicrobial Resistance Surveillance Network (KARS-Net) was established in 2019 to enhance AMR surveillance. The network has expanded from 21 laboratories in nine districts to 49 laboratories across 12 districts. The 2023 data was collected from 34 surveillance laboratories and focuses on priority bacterial pathogens.
About Antimicrobial Resistance
Antimicrobial resistance occurs when bacteria change and become resistant to antibiotics. This resistance complicates treatment and increases the risk of disease spread. Surveillance is crucial for tracking resistance patterns and informing treatment strategies.
The Role of KARS-Net
KARS-Net aims to standardise AMR surveillance in Kerala. It collects data from various laboratories to monitor resistance trends. The network has enhanced its capacity and now includes a broader range of laboratories and districts.
Priority Pathogens in 2023
The report identifies nine priority pathogens. These include Staphylococcus aureus, Enterococcus species, Klebsiella species, Escherichia coli, Acinetobacter species, Pseudomonas species, Salmonella enterica serovar Typhi and Paratyphi, Shigella species, and Vibrio cholerae. E. coli was the most frequently reported pathogen, followed by Klebsiella species.
Resistance Patterns
The 2023 antibiogram reveals concerning resistance levels. For instance, 33% of Staphylococcus aureus isolates from blood were methicillin-resistant (MRSA). Enterococcus species showed a 3% resistance to Vancomycin. Alarmingly, 12% of E. coli and 43% of Klebsiella species were identified as Carbapenem-resistant Enterobacteriaceae (CREs).
Implications for Public Health
The rising resistance levels signal a looming public health crisis. The increase in extended spectrum beta-lactamase (ESBL) production indicates that many bacteria are becoming resistant to commonly used antibiotics. This situation necessitates stringent infection control measures and rational antibiotic use.
Future Directions
To better understand community-level AMR, Kerala is implementing a hub and spoke model for surveillance. This approach aims to generate district-level antibiograms annually, providing a clearer picture of resistance trends in various healthcare settings.
Questions for UPSC:
- Critically examine the role of antimicrobial resistance in public health challenges globally.
- Discuss in the light of recent trends, the effectiveness of current antibiotic stewardship programmes in India.
- Explain the significance of surveillance networks in managing infectious diseases.
- With suitable examples, discuss the impact of antibiotic resistance on surgical and medical procedures.
Answer Hints:
1. Critically examine the role of antimicrobial resistance in public health challenges globally.
- AMR leads to treatment failures, complicating disease management and increasing morbidity and mortality rates.
- It contributes to longer hospital stays and higher healthcare costs due to the need for more expensive treatments.
- Global travel and trade facilitate the spread of resistant pathogens across borders, creating international health threats.
- AMR undermines advances in modern medicine, including surgeries and cancer therapies, which rely on effective antibiotics.
- Global initiatives, like the WHO Global Action Plan, aim to combat AMR through coordinated efforts and surveillance.
2. Discuss in the light of recent trends, the effectiveness of current antibiotic stewardship programmes in India.
- Stewardship programs aim to optimize antibiotic use, but challenges include limited awareness and training among healthcare providers.
- Recent data indicate rising resistance levels, suggesting that current programs may not be sufficiently effective in curbing misuse.
- Implementation of guidelines varies across regions and healthcare facilities, affecting overall impact.
- Public education campaigns are essential to promote rational antibiotic use among patients and the community.
- Collaboration between government, healthcare institutions, and pharmaceutical companies is critical for improving stewardship outcomes.
3. Explain the significance of surveillance networks in managing infectious diseases.
- Surveillance networks, like KARS-Net, provide essential data on AMR patterns, informing treatment guidelines and public health policies.
- They enable early detection of emerging resistance trends, allowing for timely interventions to control outbreaks.
- Collaboration among laboratories enhances data accuracy and comprehensiveness across different regions.
- Surveillance informs antibiotic stewardship efforts by identifying high-resistance areas and optimizing resource allocation.
- Such networks encourage research and development of new antibiotics and alternative therapies by denoting urgent needs.
4. With suitable examples, discuss the impact of antibiotic resistance on surgical and medical procedures.
- Increased antibiotic resistance leads to higher infection rates in surgical patients, complicating recovery and extending hospitalization.
- For example, MRSA infections can increase morbidity in post-operative patients, requiring more aggressive treatment.
- Resistance to prophylactic antibiotics can result in surgical site infections, impacting surgical outcomes and patient safety.
- In oncology, resistant infections can jeopardize chemotherapy effectiveness, leading to treatment delays or cessation.
- Overall, antibiotic resistance poses risk to the success of both elective and emergency medical procedures.
