Superbug Surge-A Tale of Seven-Year Battle Against Escalating Antimicrobial Resistance in North India

Abstract

Antimicrobial resistance (AMR) is a global health concern, significantly impacting treatment outcomes. This prospective study, conducted from 2018 to 2024, under the Indian Council of Medical Research Antimicrobial Resistance Surveillance Network (ICMR-AMRSN), aims to assess bacterial prevalence and antimicrobial resistance patterns in a tertiary care hospital in North India. Clinical specimens were collected from outpatients, inpatients, and intensive care units (ICUs). Bacterial identification and antimicrobial susceptibility testing were done as per CLSI guidelines using conventional and automated methods. Phenotypic (Combined Disk test, CarbaNP, mCIM, eCIM, PBP2a latex agglutination test, D test, Penicillin Zone Edge test) and genotypic characterisation (like CTX-M, TEM, SHV, VIM, KPC, NDM1, mecA, van, erm gene detection) of the isolates was performed. All the data was recorded and analyzed using the online ICMR-AMRSN portal. Out of a total of 1,30,077 samples,20,509 (15.8%) were culture-positive, and positivity was high from urine samples (n = 6036, 29.4%), followed by respiratory samples (n = 3739, 18.2%), deep infections (13.2%, n = 2700) and blood samples (n = 1363, 6.6%). Gram-negative bacteria predominated (n = 16,477, 80.3%), with Escherichia coli (n = 6623, 32.3%) being the most common, followed by Klebsiella pneumoniae (n = 3381, 16.5%), Acinetobacter baumannii (n = 3017, 14.7%) and Pseudomonas aeruginosa (n = 2208, 10.8%). Among Gram-positive bacteria (n = 3950, 19.2%), Staphylococcus aureus (n = 1650, 8%) was most prevalent followed by Enterococcus faecalis (n = 786, 3.8%) and Enterococcus faecium (n = 673, 3.3%). Acinetobacter baumannii was the leading ICU pathogen (n = 869,41.9%). High resistance rates were observed, particularly in carbapenem-resistant A. baumannii and methicillin-resistant S. aureus (MRSA). Genotypic analysis confirmed the presence of beta-lactamase and carbapenemase genes in key pathogens. The study highlights the substantial burden of AMR, with rising resistance trends posing therapeutic challenges. Continuous surveillance, infection control measures, and antimicrobial stewardship are crucial for combating AMR and guiding regional antibiotic policies.