Antimicrobial Resistance Trends in Community Acquired Pneumonia at Secondary care Centres in Central India: Time to Develop Community Antimicrobial Stewardship Program

Background: Community acquired pneumonia (CAP) is a significant global health burden, with high morbidity and mortality especially in developing nations. This study assessed the changing pattern of anti microbial resistance (AMR) in CAP in secondary care centres of central India. Methodology: This was a prospective observational study conducted in 10 secondary care centres in smaller cities of Central India in the state of Madhya Pradesh. Result: Among the 1315 respiratory samples analysed, 49.5% (651/1315 samples) showed significant pathological growth out of which 47.6% (626 /1315) showed bacterial growth and 1.9% (25/1315) showed fungal growth. Gram-negative bacteria accounted for 94.2% (590/626 samples) and Gram-positive bacteria for 5.7% (36/626 samples). Klebsiella pneumoniae was the most prevalent Gram-negative isolate (45%), followed by Pseudomonas aeruginosa (24.2%) and Acinetobacter spp (15.42%). Third generation cephalosporin resistance was observed in 84.6% in E. coli and 81.1% in K. pneumoniae . Carbapenem resistance was highest in Acinetobacter spp (79.1%) followed by E. Coli (45.6%), K. pneumoniae (37.2%) and P. aeruginosa (35.7%). Colistin resistance was observed in less than 10% of all gram negative isolates with the highest being in P. aeruginosa (9.8%), K. pneumoniae (7.9%), Acinetobacter spp (6.6%) and E. Coli (2.9%). Among the gram-positive isolates, 51.7% of Staphylococcus aureus were MRSA and 9.70% were resistance to vancomycin. Conclusion: AMR is no more restricted to tertiary care centres in bigger cities of India. The menace of AMR is too critical to be ignored in primary and secondary care settings. This study highlights the importance of adopting a community level ‘One-Health’ multidisciplinary approach in human-animal health and soil-environment.