Worrying factor: Due to lack of system in place there is no concrete data to determine the exact number of babies suffering from MDR
In the past decade, neo natal intensive care units in India have observed a worrying trend, as newborn babies have started developing antibiotic resistance, leaving them vulnerable to life threatening infections. As an increasing number of antibiotic resistant pathogens have pervaded the environment –food, water, soil and air –few consolidated studies have taken place on their effect on neonates, leaving on alarming anecdotal evidence to go by.
"Newborns are already compromised immune hosts, as their immunity is still developing," said Dr. Neelam Kler, one of India's foremost neonatologists, "and in India, almost 27 percent babies die of infections."
"Since 2002 onwards, there have been stray reports of antibiotic resistance in newborn intensive care units. This has lead to the use of more antibiotics, higher end antibiotics and a great economic drain," she explained.
Dr Kler, who won a Padma Bhushan for a her work in neonatology, and has been involved with Centre for Science and Environment's ongoing study into antibiotic resistance, had raised the alarm at a recent CSE meet, saying, "We are changing the whole microbiota by irrational use of antibiotics. Children are born with resistance to certain antibiotics. This not only affects the treatment of infectious diseases but is also now being linked to other types of non-communicable diseases like obesity in the later part of their lives". Speaking to dna on Thursday, she gave alarming examples of what's happening in neonatal ICUs; "The bacteria strain Klebsiella pneumoniae [causing a bacterial pneumonia] is resistant to the carbapenem antibiotic group [used to treat MDR bacteria]." Hospitals are now using the polymyxin antibiotics, which, according to Kler, are not that good. "Soon we won't even have those".
Such infections can be caused by the baby being exposed to unhealthy microbial environment on birth, vaginal tracts of women colonised by unhealthy flora instead of healthy ones, incorrect antibiotic usage on babies or expectant mothers that alters the microbiota of the baby.
If a number of babies suffering from MDR across the country cannot be determined, it's because there is no system in place to collect such data.
The most comprehensive study so far was by AIIMS in 2013, comparing home delivered babies with hospital delivered babies. Conducted in semi-urban centres in different parts of the country, it found little difference between the environments, leaving newborns exposed to MDR pathogens.
To halt and prevent antibiotic resistance, drug monitoring and antibiotic stewardship is crucial, so as to correctly identify patients who need antibiotics. This gap is what the Indian Council of Medical Research is trying to fill in a new study, which collates data from four hospitals -- AIIMS, CMC Vellore, PGIMER Chandigarh, JIPMER Pondicherry.
Take timely action
Dr Kamini Walia, deputy director ICMR, explained that the strains that cause most neonatal infections are enterobacteriaceae causing sepsis and gram negative non fermenters, more common in India than the gram positive strains. The ICMR programme is meant to facilitate enough data to reach regional centres, that cannot afford high end drugs, or costly ICU equipments. Thus the antimicrobial stewardship programme (AMSP), which Dr. Kler also emphasised as important for hospitals -- to determine timely usage, selection and de-escalation of antibiotics and optimise treatment of infections, reduce "adverse event" associated with antibiotic use.
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