Liver surgery patients report disturbing trend of multi-drug antimicrobial resistance in semi-rural Tier-2 town: Study

Hyderabad: A 26-month clinical study by the South Asian Liver Institute has revealed a disturbing prevalence of multi-drug antimicrobial resistance (MDR) among liver surgery patients in a semi-rural Tier-2 town.

The liver transplant team analysed data from 67 liver surgery patients over a 2½-year period. The study reported a 24% incidence of bacterial infections, predominantly caused by Gram-negative organisms.

Among the 46 transplant recipients, 16 cases of bacterial infection were identified. Both donors and recipients were included in the assessment.

Most infections already present before surgery

Lead investigator Prof. Dr. Tom Cherian, Head of Transplant Surgery, said, “Most worryingly, 15 of the 16 positive bacteria (94%) were resistant to first AND second line antibiotics. A smaller percentage were resistant to third-line/level antibiotics, and a few were resistant to last resort drugs like Oxazolidiones.”

He added that nine of the 16 infected patients (56%) showed positive pre-operative blood cultures, indicating that these patients “walked into hospital with the organism and all (100%) of these were MDR bacteria.”

Klebsiella and E. coli account for majority of cases

Liver critical care consultant and sub-investigator Dr. A. Gogineni noted the distribution of bacteria and resistance patterns: “Klebsiella pneumoniae & Escherichia coli were the two commonest organisms accounting for about 58% of cases. The antibiotic class most commonly resistant were Fluroquinolones, Penicillin, Cephalosporin & Nitrofurantoin.”

According to the team, this is the first documented study examining antibiotic resistance in liver transplant recipients, specifically in a semi-rural South Asian setting.

Call for a paradigm shift in infection control

Prof. Dr. Cherian emphasised that the findings demand a reassessment of longstanding infection-control strategies.

He said, “This study reveals that we need a paradigm shift in our thinking. For the last 100 years, our teachings and infection control strategies & WHO policies were to prevent spread to the patient. BUT when over 50% of the patients are walking in with such an MDR infection within themselves, this is a meaningless exercise.”

He stressed the need for active, pre-operative detection and treatment of MDR infections. “We now need to ensure such active infection is detected, controlled, and the patient in question made sterile of pathogenic bacteria, before elective surgery or treatment. This is a CRISIS of national importance and requires urgent action from all stakeholders, including the public at large.”