Vinod Kumar1, Mohit Bhatia2, Arun H. S Kumar3
1Editorial Board Member (Managing Editor-Miniseries on Dentistry), Journal of Natural Science, Biology and Medicine; Department of Pedodontics and Preventive Dentistry, Navodaya Dental College, Raichur, Karnataka, India.
2Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
3Editor in Chief, Journal of Natural Science, Biology and Medicine, University College Dublin, Dublin, Ireland.
DOI: 10.4103/jnsbm.JNSBM_138_20


Microbial cohabitation plays a significant role in regulating system-specific physiology. Some of the prominent benefits are well documented in gastrointestinal, cardiovascular, and central nervous system. In contrast, pathological outcomes from the microbial cohabitation are also reported in dermatology and dentistry. Hence, understanding the biological mechanisms and optimizing the approaches to assess the risk–benefit of microbial cohabitation to achieve optimal physiological outcomes is necessary. One of the major challenges in controlling infectious diseases globally is the prevalence of antimicrobial resistance (AMR), which makes the existing antimicrobial agents ineffective in the disease management strategy. Hence, AMR is identified as a significant contributor to global health threat with collateral health, political, and economic implications. AMR contributes to an annual mortality of around 700,000 subjects with an annual economic loss of over 2 billion Euros. Highlighting the problems of AMR is an article in this miniseries with a focus on ceftriaxone–sulbactam–ethylenediaminetetraacetic acid (EDTA) susceptibility profile of multidrug-resistant (MDR) Gram-negative bacterial isolates at a tertiary care teaching hospital in India. India has been referred to as “the AMR capital of the world.” This country carries one of the largest burdens of drug-resistant pathogens worldwide, including the alarmingly high resistance among Gram-negative and Gram-positive bacteria even to newer antimicrobials such as carbapenems and faropenem. According to the scoping report on AMR in India (2017), >70% of isolates of Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii and nearly half of all Pseudomonas aeruginosa were resistant to fluoroquinolones and third-generation cephalosporins. Resistance to drug combination of piperacillin–tazobactam was found to be <35% for E. coli and P. aeruginosa and 65% for K. pneumoniae. Increasing rates of carbapenem resistance to the tune of 71% were also observed in A. baumannii. Infections caused by MDR bacteria are usually treated with the last-resort antibiotics such as carbapenems, polymyxins, or tigecycline. However, with the emergence of carbapenem-resistant bacteria and higher toxicity profile of polymyxins and tigecycline, it is imperative that alternate treatment options such as ceftriaxone + sulbactam + disodium edetate (EDTA) highlighted in this miniseries should be looked into. Read more…

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