Anti-microbial resistance (AMR), the phenomenon of bacteria, viruses, fungi and parasites developing immunity against drugs that are used to prevent and treat infections caused by them, is showing an upward trend in hospitals and in the community in Kerala.
Significantly, the resistance to carbapenems, the broad-spectrum antibiotics effective against many types of bacteria that are resistant to other medicines, has increased over the past four years. This is part of the findings in the Annual Report 2023 of the Kerala Antimicrobial Resistance Surveillance Network (KARS-NET). The report covers the AMR data from January 1 to December 31, 2022. The data pertain to 23 surveillance laboratories from 11 districts in the State.
Health threat
The report comes at a time when the Health department is setting up block-level committees to contain AMR, perceived as a major threat to public health and a serious concern in sectors such as aquaculture, poultry farming and animal husbandry.
A section in the report titled ‘Trends of AMR in Kerala over four years’ has results of the analysis of KARS-NET data between 2018 and 2022. It was observed that production of extended spectrum beta-lactamase (ESBL) as well as the resistance to carbapenems have been increasing over the years. ESBL is an enzyme produced by various types of bacteria titled Enterobacterales, including E. Coli and Klebsiella pneumoniae, which makes them resistant to antibiotics such as penicillin. These bacteria can cause infections within health-care settings and outside.
The report analysed the resistance against carbapenem by Acinetobacter, E.coli, Klebsiella, and Pseudomonas. Acinetobacter can cause infections in the lungs, urinary tract, and blood, or in wounds in other parts of the body. Some types of E.Coli can cause diarrhoea while others can cause urinary tract infections, respiratory illness and pneumonia. Klebsiella can cause health-care-associated infections, including pneumonia, wound or surgical site infections, and meningitis. Pseudomonas can lead to infections in the blood, lungs or other body parts after surgery.
Limitation
The report also said that the resistance to Vancomycin by Enterococci bacteria has increased in the past three years while the resistance by Staphylococcus bacteria to Methicillin showed a decrease. “The data for 2020 was not included as most of the centres were unable to test and report AMR due to the pandemic. The limitation of the data is that most of the centres are tertiary-care centres, and the data may not be representative of the community,” the report says.
KARS-NET was formed by the government after the launch of the the Kerala Antimicrobial Resistance Strategic Action Plan in 2018.
