Prevalence of antimicrobial resistance in Escherichia coli and Klebsiella spp. in rural South India

• >90% of Escherichia coli and Klebsiella isolates were resistant to ampicillin.
• Piperacillin/tazobactam and carbapenems were the only effective β-lactam antibiotics.
• Cephalosporin, monobactam and fluoroquinolone resistance was very high in E. coli.
• ≥80% of isolates were susceptible to carbapenems, colistin and tigecycline.
• Nitrofurantoin had ∼ 69% efficacy against urinary isolates (76% and 47%, respectively, for E. coli and Klebsiella spp.).

The emergence and dissemination of antimicrobial resistance (AMR) is an important public health problem as resistant organisms cause difficult-to-treat infections. In this study, the prevalence of AMR in Escherichia coli and Klebsiella spp. in rural South India was examined in order to aid empirical therapy. A cross-sectional prospective study was conducted during the period from January 2012 to December 2014. Routine clinical isolates of E. coli and Klebsiella spp. were tested for antimicrobial susceptibility to β-lactams, aminoglycosides, fluoroquinolones, tetracyclines, colistin and nitrofurantoin by the Kirby–Bauer disk diffusion method and the data were documented and analyzed with one per patient analysis using WHONET software. A total of 2292 non-duplicate clinical isolates were recovered during the study period, including 1338 E. coli and 954 Klebsiella spp. The prevalence of AMR in the total isolates was as follows: amikacin, 17.3%; ertapenem, 14.4%; doripenem, 4.5%; colistin, 13.2%; and tigecycline, 4.1%. The study results indicate a high prevalence of carbapenem resistance in Klebsiella spp. especially from pus and urinary isolates, whilst the prevalence of aztreonam and fluoroquinolone resistance was very high in E. coli.