At a time when experts around the world fear that a post-antibiotic era may be on the horizon, India is facing harsh criticism from the global community for its inability to tackle its superbug epidemic. More than 58,000 infants died last year from bacterial infections that could not be treated, according to The New York Times. Now, the Center for Disease Dynamics, Economics & Policy, a Washington-based research center, is showing Indian hospitals how to track the trends of antibiotic resistance on their premises. It’s a breakthrough method that may eventually help hospitals implement strategies to tackle superbugs over the long term.
“Until recently, this was very much a developed world problem. That’s where antibiotics were used and abused,” said Keith Klugman, director of the pneumonia program at the Bill & Melinda Gates Foundation. (Disclosure: BMGF funds TakePart World.) “But very rapidly, India is taking over the rest of the developed world as a focus of resistance.”
Indeed, antibiotics are sold indiscriminately across India. Researchers at Princeton University and CDDEP found it was the biggest consumer of antibiotics worldwide in 2010. Public health activist Abhay Bang blames antibiotic abuse on what he calls the “mind-set” of doctors and patients. “Patients want quick-fix medications,” Bang said. “Doctors in competitive private medical practices have no choice but to provide them.”
CDDEP’s solution currently focuses mainly on big, multi-specialty hospitals. The magic wand: the Drug Resistance Index. Developed by CDDEP director Ramanan Laxminarayan along with Klugman, the concept was first introduced in a paper in BMJ Open, a prominent open-access journal of medical science, in 2011.
DRI pools data about two crucial sets of information: how much and which antibiotics are being consumed to target a particular bacterial species or group of species, and how resistant that microbe is in a particular setting, such as a hospital room or a country overall. That information is then compressed into one figure on a scale of 0 to 1—think of it as a Dow Jones Index for bacterial resistance. A DRI of 0 means all infections caused by a pathogen are treatable with antibiotics available at the hospital; a DRI of 1 means none of the available antibiotics can tackle it, explains CDDEP researcher Suraj Pant.
“This index provides a quick, intuitive overview on the overall state of bacterial resistance and can be used to measure the effectiveness of interventions aimed at reducing antibiotic use or preventing infections in hospital settings,” said Pant, who is supervising the collaboration in India.
CDDEP is providing technical know-how to 12 hospitals in India to calculate DRI for five to six major pathogens on a pro bono basis. “We offer our expertise to whoever approaches us,” said Pant.
But what is this index really telling us? “The main power of DRI lies in trends over time,” Pant added. For example, if the DRI of E. coli—familiar to Americans as the cause of many outbreaks of food-borne illness—is 0.4 in 2014 and 0.6 in 2016 in a particular hospital, then that means the infections caused by the pathogen have become more difficult to treat.
Some medical experts are still not convinced about DRI’s usefulness. “We’re still figuring out what it means in the Indian context,” said Chand Wattal, honorary senior consultant in the department of microbiology at Sir Ganga Ram Hospital in New Delhi. The leading hospital has been calculating DRI on its own since 2011. “It doesn’t help with day-to-day patient management,” Wattal said. “It really is geared toward helping policymakers understand trends in microbial resistance.”