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Antimicrobial Resistance (AMR): Antibiotic Overuse Is Not the Only Problem

Why in the News

A new multi-centre study by the Indian Council of Medical Research's (ICMR) antimicrobial resistance surveillance network has found that infections caused by carbapenem-resistant gram-negative bacteria are deadlier and costlier than ordinary (susceptible) infections. Conducted across 20 tertiary hospitals in the country from April 2022 to April 2025, the study has been published in The Lancet Regional Health - Southeast Asia (the October 2026 issue) and entered media discussion from 1 September 2026 (Indian Express). The study's biggest message is that India's AMR problem is not only one of unnecessary antibiotic use - late diagnosis, the spread of infection inside hospitals and a weak infection-prevention system are factors just as large.

Imaginative original symbolic image of a petri dish and capsules in a laboratory
Original symbolic image: pcsmantra.com

Definition box - essential terms

  • Antimicrobial resistance (AMR): when bacteria, viruses, fungi or parasites become resistant to the medicines that earlier killed them - treatment then becomes difficult or impossible.
  • Gram-negative bacteria: bacteria with a thin cell wall and an outer membrane (such as E. coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa); major causes of lung, urinary tract, wound and bloodstream infections.
  • Carbapenem: a powerful class of antibiotics used in serious infections - often the last resort. Resistance to it means doctors are left with almost no effective medicines.
  • Antimicrobial stewardship: the right medicine, the right dose and the right duration - an institutional system for the judicious use of antibiotics.
  • NARS-Net: the national AMR surveillance network, run by the National AMR Control Programme (since 2013) under the NCDC (National Centre for Disease Control).

The ICMR Study: Key Findings

  • Higher mortality risk: the relative risk of death among patients with carbapenem-resistant infections was higher across all four major bacteria - 1.41 times in E. coli, 1.33 times in Klebsiella pneumoniae, 1.16 times in Acinetobacter baumannii and 1.43 times in Pseudomonas aeruginosa.
  • Bloodstream infections the most dangerous: in bloodstream infections caused by carbapenem-resistant non-fermenter bacteria, the mortality rate reached 46.4 to 50.8 per cent.
  • The burden of cost: even counting only the cost of antibiotics available at Jan Aushadhi rates, treating resistant infections came out 1.1 to 2 times more expensive. ICU, beds, tests and other costs were not added - so the real economic burden is far higher.
  • The study's scope: an analysis of 1,59,336 admitted patients (17,59,597 patient-days); gram-negative infection was laboratory-confirmed in 26,213. Per the reporting, more than 61 per cent of gram-negative infections in the study were found to be carbapenem-resistant and more than 85 per cent of bloodstream infections were healthcare-associated.

The researchers also acknowledge a limit: this is an observational study, so resistance cannot be taken as a wholly independent cause of death - the severity of illness, the timing of treatment and the patient's condition also decide outcomes. Resistance should be understood as an important 'marker' of additional mortality risk.

The Problem Is Not of Medicine Alone, But of the System

The study also shows that hospitals are trying to solve with antibiotics a problem that is really a failure of infection prevention. Its main components are:

  • Late diagnosis: the time taken by bacterial analysis and resistance testing forces doctors to give broad-spectrum medicines on guesswork.
  • Transmission inside hospitals: infections tied to catheters, ventilators and other devices; infections after surgery; gaps in hand hygiene and environmental cleaning.
  • A weak surveillance link: so far surveillance has remained mostly limited to laboratory isolates; the system for looking at them joined to patient outcomes, deaths and treatment is weak.
  • Multiple factors: invasive devices, recent surgery, ongoing antibiotic pressure - AMR is the product of the mutual combination of all of these.

The Wider Context: The National and Global Burden

  • The national system: India's National AMR Control Programme began in 2013 (in the Twelfth Five-Year Plan) and the NCDC coordinates it. NARS-Net's ninth annual report (January-December 2025) includes data on 2,17,513 priority bacterial isolates from 62 sentinel sites; by March 2026 the network had reached 70 laboratories across 28 states and 6 union territories. Nine priority bacteria are monitored.
  • Global estimates: per the Global Burden of Disease (2021) analysis published in The Lancet, there were 47.1 lakh deaths worldwide associated with bacterial AMR in 2021, of which 11.4 lakh were estimated as directly attributable to AMR; by 2050 this figure is estimated to reach 19.1 lakh (attributable).
  • The economic side: prolonged illness, expensive treatment and a threat to modern medicine - surgery, cancer care, ICUs; AMR is an issue not only of health but of development too.

New Medicines: A Signal, Not a Verdict

In the study, a new antibiotic called ceftazidime-avibactam was associated with better outcomes in some resistant E. coli and Klebsiella infections. Experts treat it as an 'important signal', not proof of improvement - the study was observational and could not fully adjust for factors such as disease severity and the timing of treatment. One lesson follows: instead of endlessly escalating to new broad-spectrum medicines, better and faster diagnosis must pick the right medicine.

Way Forward: An Integrated Response

  1. Integrated surveillance: moving beyond isolate-only surveillance to join laboratory results with patient outcomes, deaths and treatment.
  2. Faster and accurate diagnosis: distinguishing bacterial from non-bacterial illness and early identification of resistance - so that medicine need not be given on guesswork.
  3. Making stewardship routine practice: not an optional programme, but a hospital's everyday process.
  4. Putting infection prevention at the centre: hand hygiene, prevention of device-related infections, proper use and early removal of invasive devices, environmental cleaning, surgical infection prevention and surveillance of hospital infections.
  5. Responsible access to new medicines: along with stewardship, so that these medicines remain effective when needed.

Conclusion

The ICMR study establishes that carbapenem resistance in India is both a serious threat to life and a heavy economic burden. Its solution does not lie in finding a new medicine every time an old one fails. Preventing infection, diagnosing early and preserving the antibiotics we have - this should be the centre of national health policy.

Practice Question (150 words, 10 marks)

"India's antimicrobial resistance problem is not one of antibiotic overuse alone, but also of systemic failure in diagnosis and infection prevention." Review this statement in the light of ICMR's recent study and suggest the components of an integrated response. (150 words, 10 marks)

Key Sources

(The global mortality figures are from The Lancet's GBD 2021 analysis (published in 2024); study-specific percentages such as 61% resistance and 85% healthcare-associated bloodstream infections are based on the reported findings.)