Antibiotics used to treat respiratory, skin infections faces high antimicrobial resistance in Hyderabad’s open drainage system: Study

AMR, or Antimicrobial Resistance, occurs when germs like bacteria, viruses, and fungi develop ways to resist the drugs meant to kill them.

BySumit Jha

Published Apr 21, 2024 | 7:00 AMUpdatedApr 21, 2024 | 7:00 AM

antimicrobial resistance hyderabad

The researchers have found that macrolide antibiotics—commonly used to treat respiratory and skin infections, faced the highest level of antimicrobial resistance (AMR) of 40 percent.

The results were based on the environmental surveillance data from the samples collected from the open drainage system in Hyderabad.

The study suggests that bacteria were more likely to develop resistance to macrolides antibiotics, highlighting a significant challenge in treating infections effectively.

AMR, or Antimicrobial Resistance, occurs when germs like bacteria, viruses, and fungi develop ways to resist the drugs meant to kill them, making infections harder to treat and posing a serious threat to public health.

Macrolides are being used for the treatment of respiratory illnesses such as pneumonia, sinusitis, pharyngitis, and tonsillitis as well as for skin infections.

Azithromycin, clarithromycin, and erythromycin are the common antibiotics of the Macrolides drug class.

Also Read: What is AMR? Which is touted as the silent pandemic by doctors 

Wastewater surveillance

The researchers from the Tata Institute for Genetics and Society (TIGS) in Bengaluru, and the CSIR-Centre for Cellular and Molecular Biology (CCMB) in Hyderabad conducted wastewater surveillance of the open drainage system in Hyderabad.

They collected samples in January 2022 from 17 sampling sites, including 10 open drains, four rivers, and three lakes, all of which receive untreated sewage water from households, industries, and farming practices in the city.

One of the authors of the study— Director of TIGS Dr Rakesh Mishra explained to South First the importance of wastewater surveillance.

He says,  “The open drainage system carries human and livestock waste along with the pathogens present in these settings. Environmental samples reveals a high prevalence of antibiotic resistance signatures, indicating a concerning trend.”

“As per WHO, AMR is considered as one of the top ten global public health threats to humanity in the 21st century and is thus a silent pandemic,” adds Dr Mishra.

Also Read: 3 out of 4 patients prescribed antibiotics, elevating risk of AMR

Consequences of AMR

He said that the study shows a wide range of antibiotic resistance being developed in various disease-causing bacterial species, suggesting that people or animals carrying these infections are introducing resistant bacteria into their surroundings.

“This poses a serious threat as individuals may suffer severe consequences or even death depending on the severity of the disease,” said Dr Mishra.

The trend of increasing antibiotic use is expected to continue, further exposing bacteria to the challenge of developing resistance.

Bacteria, much like viruses, possess a high replication rate and can generate mutations with each division, allowing them to adapt and survive.

Continuous exposure to antibiotics may cause further resistant mutations, enriching the environment with resistant bacteria.

It should be mentioned that Around 2.14 million neonatal sepsis deaths occurring globally are attributable to resistant pathogens every year.

Moreover, according to the World Bank Report, AMR could lead to a 7.5 percent decline in livestock by 2050. Not only that, under the high AMR impact scenario, it has been estimated that the world could lose over 3.8 percent of annual GDP by 2050.

Also read: A missing piece in Kerala’s antimicrobial resistance puzzle

Other antibiotics

The study indicates that, aminoglycosides, the other classes of antibiotics also showed resistance, with a 24.4% resistance observed in the samples.

Aminoglycoside antibiotics are used to treat various bacterial infections, including UTIs, respiratory tract infections like pneumonia, peritonitis, and skin infections, with common examples including Amikacin, Neomycin, and Streptomycin.

Furthermore, tetracycline exhibited an 11.3 percent resistance rate, while lincosamide showed a 6.7 percent resistance rate.

Tetracycline is prescribed for a wide range of infections, including acne, skin, respiratory, urinary, and genital infections, and is available in various formulations such as Tetracycline hydrochloride, tigecycline, doxycycline, and minocycline.

Lincosamide antibiotics, like clindamycin, are mainly used for anaerobic bacterial and Gram-positive cocci infections, effective against skin, dental, respiratory, and pelvic infections.

Clindamycin comes in oral capsules, topical creams, and intravenous injections, often serving as an alternative when other antibiotics are ineffective.

Opinioning on the issue, Dr Mishra says, “People are using a variety of antibiotics. This is why exposure to antibiotics, particularly unplanned or excessive exposure, accelerates the emergence of AMR.”

“What might take decades to develop AMR in normal conditions could occur within a few years due to constant/excessive exposure to antibiotics. This is the trend we’re seeing, and if we don’t take action, there would be severe consequences,” said Dr Mishra.

Also read: Study finds prevalence of antibiotic resistance in rural Karnataka

The changes in the gene of the bacteria

The study also found that the most prevalent antimicrobial resistance gene (ARG) — a gene found in bacteria that helps them resist the effects of antibiotics— “mutations in the 23S rRNA gene conferring resistance to macrolide antibiotics” was present in multiple pathogens.

These pathogens responsible for various diseases include:

  • Escherichia coli: Food poisoning and urinary tract infections.
  • Campylobacter jejuni: Gastrointestinal infections, often from contaminated food.
  • Acinetobacter baumannii: Serious infections, especially in hospitalised patients.
  • Streptococcus pneumonia: Pneumonia, meningitis, and other infections.
  • Pseudomonas aeruginosa: Lung, urinary tract, and wound infections.
  • Neisseria gonorrhoea: Gonorrhoea, a sexually transmitted infection.
  • Klebsiella pneumonia: Pneumonia, bloodstream infections.
  • Helicobacter pylori: Infecting the stomach lining, leading to ulcers and stomach inflammation.

ARG is a gene found in bacteria that helps them resist antibiotics’ effects.

Dr Mishra also speaks about the way forward with AMR, “We know what the resistance signatures are, so we can specifically test individuals or environmental samples. Treatment can then be planned accordingly.”

“Additionally, we’re aware of which antibiotics will be ineffective because resistance has already been detected in environmental samples. This means those antibiotics won’t work, so we must find substitutes, develop completely new antibiotics, or strategically use modifications or combination of the existing ones” said Dr Mishra.

He pointed out that AMR is not just a concern for humans; it also affects livestock and the broader environment.

AMR to affect livestock

The study gives an unbiased picture of the antimicrobial-resistant bacterial communities in the environment that can potentially infect a broader range of hosts, including livestock, birds, animals and humans.

Dr Mishra explains,”Livestock and poultry use a large number ofantibiotics. The bacteria that are pathogenic to poultry or cattle may not naturally pathogenic to humans. However, resistance in bacteria can occur through a process called lateral gene transfer.”

He stated, “This process can transfer ARGs from one bacterium to another. If these bacteria, carrying ARGs, opportunistically infect other hosts, they can potentially spread resistance across diverse hosts.”

The study notes, “The future challenge is to combat the problem of antimicrobial resistance not only at health care centres but also in the environments that the humans share with the pathogens of concern and their other hosts.”

(Edited by Sumavarsha Kandula)