# Differing Rates of Carbapenem Resistance in Gram-Negative Bacteria Within Lower and Higher Socioeconomic Classes in Eastern India

## TL;DR

This study found similar rates of carbapenem resistance in Gram-negative bacteria among different socioeconomic groups in Eastern India, suggesting the issue affects all communities.

## Contribution

The study reveals that carbapenem resistance is not confined to a specific socioeconomic class in Eastern India.

## Key findings

- Gram-negative bacilli showed higher carbapenem resistance compared to coccobacilli.
- No significant difference in resistance rates was found between higher and lower socioeconomic classes.
- Common isolates like E. coli and Klebsiella pneumoniae showed no correlation with socioeconomic status and resistance.

## Abstract

Background

Over the last 50 years, medical science has witnessed the emergence of antibacterial resistance at a concerning rate. Southeast Asia has become a leading epicenter for the development and spread of carbapenem-resistant bacterial strains. Socioeconomic background, being a major health determinant, can heavily affect this rate of antibiotic resistance.

Methods

This retrospective study was conducted at a 1,700-bed tertiary care facility in Kolkata, India, between October 2023 and January 2024. A total of 248 culture results from urine, sputum, blood, wound, and ascitic fluid, which showed growth of Gram-negative bacilli (GNB) and coccobacilli (GNCB) during the study period, were analyzed. Medical records were reviewed to collect demographic and clinical data. The comparison was made between two population groups based on economic status, identified by ration cards as defined by the Government of West Bengal, India.

Results

This study assessed the prevalence and antibiotic resistance patterns of Gram-negative bacteria in clinical samples, focusing on urine, blood, sputum, wound, and ascitic fluid. The analysis revealed that GNB were widely distributed across sample types, while GNCB showed higher prevalence in blood and ascitic fluid. Antibiotic resistance was notably prevalent among GNB, with 49 (27.5%) resistant to imipenem and 50 (28.1%) to meropenem. GNCB exhibited lower resistance, with six (14.3%) resistant to imipenem, eight (19.0%) to meropenem, and seven (16.7%) to doripenem. A comparison of carbapenem resistance (CR) between higher and lower socioeconomic classes showed no statistically significant differences, with resistance rates of 15 (41.7%) and 96 (45.3%), respectively. Further analysis of the most common isolates (Acinetobacter baumannii, Escherichia coli (E. coli), Klebsiella pneumoniae, and Pseudomonas aeruginosa) also revealed no significant correlation between socioeconomic status and resistance, emphasizing that antibiotic resistance is a widespread issue transcending economic boundaries.

Conclusion

This study examines CR in Gram-negative bacteria across socioeconomic groups in Eastern India, finding no significant differences in resistance between higher and lower economic classes. Both groups showed similar levels of resistance, highlighting that antibiotic misuse, overprescription, and inadequate stewardship are pervasive issues transcending economic boundaries. The study emphasizes the need for enhanced healthcare provider training, public education on antibiotic misuse, and policy interventions to improve sanitation and waste management. Effective antibiotic stewardship and public health measures are crucial for combating resistance and ensuring equitable health outcomes.