Context: A major Indian Council of Medical Research (ICMR) study covering 159,336 hospitalised patients across 20 tertiary-care hospitals found that carbapenem-resistant bacterial infections are associated with higher mortality, longer hospitalisation and greater antibiotic costs. The findings highlight the need to strengthen antimicrobial resistance (AMR) prevention, infection control and timely diagnostics.
What is Antimicrobial Resistance (AMR)?
AMR occurs when microorganisms such as bacteria develop the ability to survive medicines designed to kill or inhibit them, making infections harder to treat.
Resistant bacteria can transmit resistance traits to their offspring and, in some cases, to other bacteria through DNA exchange.
AMR can cause previously controllable infections to re-emerge and reduces the effectiveness of available antibiotics.
Major Causes of Antibiotic Resistance
Overuse and inappropriate use of antibiotics creates selection pressure favouring resistant bacteria.
Resistance can also arise through genetic mutations and spread through poor infection-control practices.
Inadequate sanitation, poor hygiene and antibiotic use in agriculture further contribute to the problem.
Excessive dependence on antibiotics can therefore undermine their effectiveness as a critical public-health resource.
Why Carbapenem Resistance is Particularly Concerning?
Carbapenems are powerful, broad-spectrum antibiotics generally reserved for serious bacterial infections, particularly when other antibiotics are ineffective.
Resistance to carbapenems leaves doctors with fewer effective treatment options, increasing the risk of treatment failure and death.
Carbapenem resistance is therefore an important marker of high-priority AMR.
Findings of the ICMR Study
The ICMR AMR Surveillance Network analysed data from 20 tertiary-care hospitals between April 2022 and April 2025.
About 61.1% of infections involving the four major bacteria studied were resistant to carbapenems.
The study examined:
Escherichia coli – commonly associated with urinary tract infections.
Klebsiella pneumoniae – causes urinary and respiratory infections.
Acinetobacter baumannii – associated with ventilator-associated pneumonia, bloodstream and wound infections.
Pseudomonas aeruginosa – can cause bloodstream, eye and ear infections.
Higher Mortality from Resistant Infections
Bacteria
Mortality: Resistant
Mortality: Susceptible
E. coli
24.4%
17.3%
K. pneumoniae
31.2%
23.5%
A. baumannii
37.9%
32.8%
P. aeruginosa
28.9%
20.2%
Relative risk of death was 41% higher for carbapenem-resistant E. coli, 33% for K. pneumoniae, 16% for A. baumannii and 43% for P. aeruginosa.
In bloodstream infections, mortality ranged from 39.3% for E. coli to 50.8% for A. baumannii.
More than 85% of bloodstream infections involving these four bacteria were classified as healthcare-associated, highlighting the importance of hospital infection prevention and control.
Resistant Infections are More Expensive
Average antibiotic costs were substantially higher for resistant infections:
E. coli: ₹39,846 vs ₹20,034.
K. pneumoniae: ₹55,688 vs ₹47,918.
A. baumannii: ₹62,150 vs ₹41,372.
P. aeruginosa: ₹66,599 vs ₹48,392.
These estimates are conservative, as the study considered only antibiotic costs and excluded ICU expenses, hospital beds, diagnostics, procedures, supportive care and consultation charges.
Hence, the actual economic burden on patients, families and the healthcare system is likely to be considerably higher.
Infection Prevention and Control (IPC): The First Line of Defence
IPC refers to measures that prevent infections from developing and spreading, thereby reducing the need for antibiotics.
Key measures include:
Hand hygiene and environmental cleaning.
Prevention of device-associated infections.
Appropriate insertion and early removal of invasive devices such as catheters and ventilators.
Surgical-site infection prevention.
Surveillance of healthcare-associated infections.
Vaccination and general hygiene to reduce infections and antibiotic demand.
Effective IPC reduces both infection transmission and antibiotic selection pressure.
Beyond the Problem of Antibiotic Overuse
AMR should not be viewed solely as a consequence of excessive antibiotic consumption.
Important contributors in hospitals include healthcare-associated transmission, invasive medical devices, recent surgery, inadequate infection control and delayed diagnosis.
Hospitals need timely and accurate diagnostics to identify resistant pathogens and enable targeted treatment instead of unnecessary dependence on broad-spectrum antibiotics.
Need for Integrated AMR Surveillance
Surveillance should connect laboratory findings with patient-level outcomes, including treatment, mortality and clinical progression.
Such integrated data can help identify:
High-risk infections and settings.
Healthcare-associated transmission.
Mortality patterns.
Treatment effectiveness.
Emerging resistance trends.
This can enable a shift from merely monitoring resistance to using surveillance data for timely clinical and public-health action.
Limitations of the Study
The study involved tertiary-care hospitals, which often manage referred and critically ill patients; therefore, its findings may not directly represent the entire Indian population.
It lacked patient-level information on factors such as severity of illness, speed of appropriate treatment, infection source and specific resistance mechanisms.
Hence, the findings reflect real-world treatment patterns and associations rather than establishing that resistance alone universally causes the observed outcomes.
Way Forward
Place infection prevention and control at the centre of India's AMR response, alongside antibiotic stewardship.
Strengthen diagnostic capacity so that antibiotics can be selected according to the actual pathogen and its resistance profile.
Promote antibiotic stewardship—the rational selection, dose and duration of antibiotics.
Integrate laboratory surveillance, patient outcomes and mortality data for better decision-making.
Strengthen hygiene, vaccination, sanitation and hospital infection-control systems to prevent infections before antibiotics are required.
Preserve existing antibiotics through responsible use; AMR cannot be addressed merely by developing new antibiotics whenever existing ones fail.
