Emergence of antibiotic-resistant bacterial strains , methicillin-resistant Staphylococcus aureus , extended spectrum beta lactamases , and multi-drug resistance is a problem similar to global warming

Address to: Dr. Pranab Kumar Bhattacharya. Depto of Pathology/District Medical College. Station Road 742101 Berhampore, Murshidabad, West Bengal, India. Phone: 91 92 3151-0435 e-mail: profpkb@yahoo.co.in Received 11 June 2014 Accepted 26 November 2014 Emergence of antibiotic-resistant bacterial strains, methicillin-resistant Staphylococcus aureus, extended spectrum beta lactamases, and multi-drug resistance is a problem similar to global warming

The prevalence of MRSA has increased in most private health care institutions, including Kolkata City of West Bengal, India, where it increased from 6.9% in 1988, to 54% in 2003, to 63% in 2013, varying from 8% to 71% across India 6 .Resistance is due to an altered penicillin binding protein encoded by the mecA gene.MRSA can be confi rmed using multiplex PCR-based detection of the mecA2 gene using the ATA3` mecA1 forward (5`GTAGAAATGACTGAACGTCCG) and reverse (5`CCATTCCACATTGTTTC) primers, as well as the oxacillin disk diffusion (ODD) and cefoxitin disk diffusion (CDD) tests.Although considered the gold standard for MRSA diagnosis, PCR for the mecA gene is costly and requires a skilled technician; thus, many tertiary care hospitals and even medical colleges or private centers in West Bengal cannot afford to routinely perform PCR.ODD has a sensitivity of 97%, specifi city of 95%, and an effectiveness of 97%; and CDD has sensitivity, specifi city, and effectiveness of 100% for the diagnosis of MRSA infection when compared with PCR for mecA.In Kolkata, common causative organisms of hospital-acquired infections are Staphylococcus aureus, Streptococcus viridans, aerobic gram-negative bacilli such as Pseudomonas aeruginosa, Escherichia coli, and other MDR gram-negative organisms, including Acinobacter, Klebsiella, E. coli, Salmonella, and extended spectrum beta lactamase (ESBL) enterobacteriaceae (E. coli and Klebsiella; prevalence,62-100%), and S. aureus, responsible for various mild to serious infections in multiple hospital units, leading to a higher median total hospital cost, longer hospital stay after infection (mean 22.9 days 6 ), fatal sepsis, and death (mean 84% 5 ).MRSA and methicillin-sensitive S. aureus strains with quinolone resistance have also been reported from an eye care hospital in Bhubaneswar, India

ACKNOWLEDGMENTS REFERENCES
necrotizing fasciitis to fatal sepsis.In one of our studies, when 336 individuals in the community were randomly screened from their deeper nasal cavity for persistence of S. auerus, the fi rst 136 subjects showed no MRSA, whereas in the next 200 subjects, only 11%showed MRSA.In another study from Wardha, India, of 280 CAMRSA samples, 51.8% had the mecA gene 5 .CAMRSA colonizes the anterior nares, and nasal carriage of S. aureus acts as an endogenous reservoir for clinical infections in colonized individuals or as a source of crosscolonization for community-based infections.Nasal S. auerus colonization is an important risk factor for life-threatening infections of the carrier.In our CAMRSA study, the overall incidence of S. aureus was 12-28%, even in healthy subjects: a higher prevalence may occur in overcrowded and slum areas.
MRSA results in surgical site infection, non-healing ulcer, necrotizing fasciitis, pneumonia, urinary tract infection, and central venous catheter-associated infections.Due to use of previous third-generation antibiotics in critical care units, coagulase-negative staphylococci cause major infections, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, and non-albicans Candida -producing bio fi lms in urinary catheters; nasogastric, parenteral nutrition, and tracheostomy tubes; and mechanical ventilators.Risk factors and mortality rate are always higher with MRSA infection.Comorbid conditions that act as risk factors include cancer, heart disease, nephropathy, diabetes mellitus, chronic obstructive pulmonary disease, polytrauma, dyslipidemia, human immunodefi ciency virus, cystic fi brosis, hepatitis, pulmonary emphysema, dialysis, and tobacco and marijuana smoking.
Today, the persistent, indiscriminate, and inappropriate use of antibiotics and the increasing specter of antibiotic resistance are an emerging critical situation for healthcare.This situation needs immediate action with current anti-infective therapies in West Bengal.MDR organisms will continue to increase unless clinicians in most care hospitals and private practices improve the rational use of antibiotics.The matter is rendered increasingly complicated due to the presence of ESBL and carbapenamase-producing organisms due to the blinded use of third and fourth-generation antibiotics.The potential for misuse and abuse of antibiotics was recognized shortly after their introduction into West Bengal; this may have been further escalated by failure to obtain appropriate culture and in vitro sensitivity reports for lower respiratory and urinary tract infections and pus.Meropenem or tazobactam is routinely used as the choice fi rst-line antibiotic in most private care hospitals and nursing homes and for some doctor's prescriptions; this is due to kickbacks in the form of monetary commissions from pharmacy houses.We need urgent implementation of an effective antibiotic policy, and the basis of that policy rests on generating microbiological data and prescription audits through electronic prescriptions to be introduced to all public and private health care institutes(where approximately 60% of antimicrobial use is inappropriate) or at any geographical location where drug resistance has developed.
Antibiotic resistance is no less a problem than global warming.Moreover, the overuse of antibiotics causes the emergence of bacterial resistance and increases healthcare costs and sepsis-related deaths.We propose the development of a new global organization to lead the battle against antibioticresistant pathogens and call for this organization to be modeled on the organization created to combat global warming, the Intergovernmental Panel on Climate Change.This organization would be comprised of specialists in clinical and pathological medicine and include epidemiologists, microbiologists, pharmacologists, health economists, and international lawyers.