Publication Type : Journal Article
Publisher : Elsevier BV
Source : IJID Regions
Url : https://doi.org/10.1016/j.ijregi.2025.100605
Keywords : Klebsiella pneumoniae, Uncomplicated urinary tract infections, Antimicrobial agents
Campus : Faridabad
School : School of Medicine
Year : 2025
Abstract : Objectives Knowledge of local antibiotic susceptibility rates is essential to strengthen antimicrobial stewardship programs. DASH to Protect Antibiotics (https://dashuti.com/), promotes the dissemination of focused local antibiograms in community urinary tract infection (UTI). This study mapped the susceptibility profile of Klebsiella pneumoniae from 18 Indian centers. Methods The centers spanned nine Indian States and three Union Territories. Urinary K. pneumoniae antibiograms from the outpatient clinic were collated and analyzed. Standardization was achieved through online training. For epidemiological purposes, five centers tested fosfomycin. Results Overall, low susceptibility (<60%) was observed for the standard oral antibiotics prescribed for cystitis: co-trimoxazole, 54% (36-68%); ciprofloxacin, 52% (29-55%); amoxicillin-clavulanic acid, 46%, (35-82%); nitrofurantoin, 39% (19-78%); and cefuroxime, 30% (15-62%). The rates for third- and fourth-generation cephalosporins were 49% (45-52%) and 60% (36-76%), respectively. Extended-spectrum beta-lactamases ranged from 36-61% in India. Piperacillin-tazobactam 74% (65-87%), amikacin 76% (45-91%), and meropenem 81% (61-87%) exhibited higher activity. Fosfomycin was the most active antimicrobial, with 89% (92-97%) susceptibility. K. pneumoniae susceptibility was directly linked to geographic region, log gross domestic product (P <0.001), and humidity, and low and high temperatures (P <0.05). Conclusions Oral treatment options for K. pneumoniae cystitis are rapidly decreasing. Northern and southern India showed significant differences in antimicrobial susceptibility, highlighting the importance of local antibiograms for promoting antimicrobial stewardship. For uncomplicated cystitis, co-trimoxazole (54%) may be the empirical choice. Good susceptibility to fosfomycin was observed (89%). The empirical use of fluoroquinolones, cephalosporins, and amoxicillin-clavulanic acid has been discouraged. Piperacillin-tazobactam and aminoglycosides are carbapenem-sparing agents.
Cite this Research Publication : Meher Rizvi, Shalini Malhotra, Hiba Sami, Jyotsna Agarwal, Areena H. Siddiqui, Sheela Devi, Aruna Poojary, Bhaskar Thakuria, Isabella Princess, Aarti Gupta, Amal Al Malehi, Asfia Sultan, Ashish Jitendranath, Balvinder Mohan, Fatima Khan, Hatim El Tahir, Nainaraj Ilanchezhiyan, Mannu Jain, Maria Khan, Narendra Pal Singh, Renu Gur, Sarita Mohapatra, Shaika Farooq, Vellore Ramanathan Yamunadevi, Ken Masters, Nisha Goyal, Manodeep Sen, Razan Al Zadjali, Rugma Rajendradas, Suneeta Meena, Sudip Dutta, Bradley Langford, Reba Kanungo, Zaaima Al Jabri, Arwa Al Rajaibi, Sanjeev Singh, Azza Al Mamari, Sarman Singh, Keith H. St John, Raman Sardana, Pawan Kapoor, Amina Al Jardani, Rajeev Soman, Abdullah Balkhair, Neelam Taneja, Klebsiella pneumoniae urinary tract infection: A multicentric study highlights significant regional variations in antimicrobial susceptibility across India, IJID Regions, Elsevier BV, 2025, https://doi.org/10.1016/j.ijregi.2025.100605