High mortality in pvt hospitals due to drug resistance

Mortality in Indian private hospitals is “significantly higher” in patients infected by multi-drug resistant or extremely drug-resistant strains of bacteria.

The death rate varies between 13-29% depending on the type of bacteria, says a new research on more than 5,000 patients admitted in 10 top private hospitals in five metropolia including Bengaluru in 2015.

The results make it very clear – those who acquire drug-resistant infections, as opposed to similar drug-susceptible infections, have greater odds of mortality. Pathogens were classified as MDR or XDR based on drug susceptibility profiles.

Study results indicate patients who acquired MDR bacterial infections were 1.57 times more likely to die, compared to patients who respond to antibiotics. Patients who acquired XDR infections were 2.65 times more likely to die.

“These mortality rates are much higher than for high-income countries. The overall mortality rate among all participants was 13.1% with mortality as high as 29% among patients infected with A. baumannii. In the western world, mortality rates are typically under 7%,” said Ramanan Laxminarayan, lead author of the study at the Center for Disease Dynamics, Economics and Policy, Washington, DC.

“The study also bunks the popular perception that private hospitals are cleaner and better. People are dying as infection rates are unacceptably high. The level of resistance is very high.” he told DH.

Two hospitals were from Bengaluru while the rest were from Delhi (4), Mumbai (2), Jaipur (1) and Kolkata (1). The identity of the hospitals has not been disclosed.

The findings – published in the journal Infection Control and Hospital Epidemiology - come a year and a half after India prepared its national action plan to tackle the growing public health threat coming from antibiotic resistance.

“But the progress so far is limited,” said Chandra Bhusan, deputy director general at Delhi-based Centre for Science and Environment, which is not associated with the study.

Resistance to antibiotics is globally recognised as a public health threat of an unprecedented scale. It is expected to lead to a 3.8% loss in GDP and 10 million deaths annually by 2050.

As antibiotics are increasingly becoming ineffective, common infections and diseases, which were earlier treatable, are now becoming difficult to treat.

Once a pillar for antibiotic therapy, third-generation cephalosporins are largely ineffective against several common infections and rates of carbapenem-resistance are as high as 57% in some Indian healthcare settings. Carbapenem is one of the last resort antibiotics.

“The problem for India is that rates of hospital infections and of drug resistance are higher than other countries for similar GDP. Because of a huge population, this translates to a much larger disease burden associated with resistance,” said Laxminarayanan, who is also associated with Princeton University.