ABSTRACT

The ever-evolving emergence of multidrug-resistant bacteria has brought mankind to the edge of a possible existential free fall. The designing of novel antibiotics to eradicate these deadly infections has been expertly countered by the remarkable adaptive capabilities of multidrug-resistant superbugs. The rapid horizontal dissemination of extended-spectrum β-lactamase (ESBL) and carbapenemase enzymes by nosocomial pathogens belonging to the gram-negative Enterobacteriaceae family is proving to be one of the biggest global public health threats, accompanied by grave clinical and economic impacts. The ability of these enzymes to hydrolyze the most advanced β-lactams imparts the carrier organisms resistance towards the newest of the cephalosporins, as well as the last resort carbapenems. Their frequent aminoglycoside and fluoroquinolone co-resistance has left us with a handful of treatment options, including the old antibiotics like colistin and fosfomycin. In India, most of the data related to the above-mentioned organisms are largely disorganized and, understandably, unclear. This review attempts to briefly discuss the ESBL and carbapenemases along with the summing up of the information regarding the emergence and transmission of ESBL and carbapenemase genes via the Enterobacteriaceae group in the Indian health setup, during the last decade, in a zone-wise manner. The incidences of infection by these enterobacteria, along with their ESBL and carbapenemase profiles, are discussed in detail based on the reports published by various national and global research teams from all corners of the country. The paper also highlights the need to report these organisms immediately after they are encountered in the clinics, for the prevention of their dissemination, as large information gaps seem to exist in specific regions of India.