{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:30:51Z","timestamp":1793143851875,"version":"4.5.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2018,11,8]],"date-time":"2018-11-08T00:00:00Z","timestamp":1541635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We 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\u20133 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciy955","type":"journal-article","created":{"date-parts":[[2018,11,6]],"date-time":"2018-11-06T23:11:55Z","timestamp":1541545915000},"page":"563-570","source":"Crossref","is-referenced-by-count":196,"title":["The Mortality Burden of Multidrug-resistant Pathogens in India: A Retrospective, Observational Study"],"prefix":"10.1093","volume":"69","author":[{"given":"Sumanth","family":"Gandra","sequence":"first","affiliation":[{"name":"Center for Disease Dynamics, Economics & Policy, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie K","family":"Tseng","sequence":"additional","affiliation":[{"name":"Center for Disease Dynamics, Economics & Policy, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Arora","sequence":"additional","affiliation":[{"name":"Fortis Healthcare Ltd., Gurgaon, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhaskar","family":"Bhowmik","sequence":"additional","affiliation":[{"name":"Fortis Healthcare Ltd., Gurgaon, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L","family":"Robinson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bishnu","family":"Panigrahi","sequence":"additional","affiliation":[{"name":"Fortis Healthcare Ltd., Gurgaon, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramanan","family":"Laxminarayan","sequence":"additional","affiliation":[{"name":"Center for Disease Dynamics, Economics & Policy, Washington, DC"},{"name":"Princeton Environmental Institute, Princeton University, New Jersey"},{"name":"Department of Global Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eili Y","family":"Klein","sequence":"additional","affiliation":[{"name":"Center for Disease Dynamics, Economics & Policy, Washington, DC"},{"name":"Department of Emergency Medicine, Johns Hopkins School of Medicine"},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, 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