Evidence map›Paper›PMID 30407501›Full record

Observational studyClinical infectious diseases : an official publication of the Infectious Diseases Society of America2019

The Mortality Burden of Multidrug-resistant Pathogens in India: A Retrospective, Observational Study.

Sumanth Gandra, Katie K Tseng, Anita Arora, Bhaskar Bhowmik, Matthew L Robinson, Bishnu Panigrahi, Ramanan Laxminarayan, Eili Y Klein

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 97 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
97citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

97 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  4. Development and Prospective Validation of a Machine Learning Tool for Predicting Multidrug-resistant Organism Infections in an Indian Critical Care Unit.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026
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37 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Sumanth GandraCenter for Disease Dynamics, Economics & Policy, Washington, DC.
Katie K TsengCenter for Disease Dynamics, Economics & Policy, Washington, DC.
Anita AroraFortis Healthcare Ltd., Gurgaon, Haryana, India.
Bhaskar BhowmikFortis Healthcare Ltd., Gurgaon, Haryana, India.
Matthew L RobinsonDivision of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Bishnu PanigrahiFortis Healthcare Ltd., Gurgaon, Haryana, India.
Ramanan LaxminarayanCenter for Disease Dynamics, Economics & Policy, Washington, DC.
Eili Y KleinCenter for Disease Dynamics, Economics & Policy, Washington, DC.

Funding

Antibacterial Resistance Leadership Group (ARLG)UM1AI104681 · NIAID · DUKE UNIVERSITY · PI Vance G. Fowler, Henry F HENRY CHAMBERS · 2013 to 2026
$180.8M
NIAID NIH HHS UM1 AI104681
6 · The paper itself

Abstract

backgroundThe threat posed by antibiotic resistance is of increasing concern in low- and middle-income countries (LMICs) as their rates of antibiotic use increase. However, an understanding of the burden of resistance is lacking in LMICs, particularly for multidrug-resistant (MDR) pathogens.

methodsWe conducted a retrospective, 10-hospital study of the relationship between MDR pathogens and mortality in India. Patient-level antimicrobial susceptibility test (AST) results for Enterococcus spp., Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. were analyzed for their association with patient mortality outcomes.

resultsWe analyzed data on 5103 AST results from 10 hospitals. The overall mortality rate of patients was 13.1% (n = 581), and there was a significant relationship between MDR and mortality. Infections with MDR and extensively drug resistant (XDR) E. coli, XDR K. pneumoniae, and MDR A. baumannii were associated with 2-3 times higher mortality. Mortality due to methicillin-resistant S. aureus (MRSA) was significantly higher than susceptible strains when the MRSA isolate was resistant to aminoglycosides.

conclusionsThis is one of the largest studies undertaken in an LMIC to measure the burden of antibiotic resistance. We found that MDR bacterial infections pose a significant risk to patients. While consistent with prior studies, the variations in drug resistance and associated mortality outcomes by pathogen are different from those observed in high-income countries and provide a baseline for studies in other LMICs. Future research should aim to elucidate the burden of resistance and the differential transmission mechanisms that drive this public health crisis.

Indexed as

BacteriaBacterial InfectionsDrug Resistance, Multiple, BacterialAdolescentAdultAgedAnti-Bacterial AgentsChildChild, PreschoolCommunity-Acquired InfectionsCross InfectionFemaleHumansIndiaInfantInfant, NewbornAnti-Bacterial Agentsantimicrobial resistancehealth care–acquired infectionslow- and middle-income countriesmultidrug-resistant organisms

Identifiers

PMID30407501
PMCPMC6669283

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.