The Indian Council of Medical Research (ICMR) has released its seventh annual report for 2023 on Antimicrobial Resistance (AMR) in India. The report reviews data from January to December 2023, offering a detailed look at how antibiotic resistance is worsening in the country. It highlights the growing inability of common antibiotics to treat infections, raising concerns about the future of healthcare.
Antibiotics Tested Against Common Infections
The report focused on antibiotics typically used to treat diseases like respiratory infections, diarrhoea, fevers, pneumonia, sepsis, and bloodstream infections. These antibiotics were tested on bacteria commonly found in such infections, including Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus. Samples were collected from outpatient departments (OPDs), wards, and intensive care units (ICUs) across India.
ICMR collected data from 99,492 culture-positive samples. These came from different sources like blood, urine, infections of the lower respiratory tract, and even deep infections in the body. Over 21 public and private centres from across India contributed to this important surveillance data.
Alarming Trends of Antibiotic Resistance
The results from these samples revealed a growing problem: many common antibiotics are becoming less effective. The bacteria tested showed increasing resistance to antibiotics, especially those used for treating serious infections.
The report studied antibiotics like amikacin, cefotaxime, ceftazidime, ciprofloxacin, levofloxacin, piperacillin-tazobactam, imipenem, meropenem, and colistin. These antibiotics are part of a special group known as “Critically Important Antimicrobials” (CIA) and “Highest Priority Critically Important Antimicrobials” (HPCIA), which are essential for both human and animal health. According to the World Health Organization (WHO), it’s critical that these antibiotics be used responsibly to maintain their effectiveness.
Bacteria Show Increased Resistance Over Time
Escherichia coli (E. coli), a common bacterium found in hospitals, clinics, and outpatient settings, was particularly resistant to several antibiotics. In fact, E. coli showed less than 20% susceptibility to cefotaxime, ceftazidime, ciprofloxacin, and levofloxacin. This means these antibiotics, which were once effective, are now failing to control infections in most cases.
Antibiotic resistance worsened over the years. For example, piperacillin-tazobactam saw its effectiveness fall from 56.8% in 2017 to just 42.4% in 2023. Similarly, amikacin dropped from 79.2% in 2017 to 68.2% in 2023. The susceptibility of E. coli to imipenem and meropenem, two key antibiotics, also dropped sharply. Imipenem’s effectiveness decreased from 81.4% to 62.7%, and meropenem fell from 73.2% to 66%.
Klebsiella pneumoniae, another significant bacteria causing infections, showed a similar pattern. Piperacillin-tazobactam effectiveness fell from 42.6% to 26.5%, while imipenem and meropenem dropped from 58.5% to 35.6% and 48% to 37.6%, respectively. This reduction in effectiveness is particularly concerning because these antibiotics are critical for treating severe bacterial infections.
Pseudomonas aeruginosa, a bacterium known for causing hospital-acquired infections, also became more resistant to antibiotics over time. Imipenem resistance in Pseudomonas increased from 26% in 2017 to 38.5% in 2023. Similarly, meropenem resistance rose from 31.3% to 34.5%. Fluoroquinolones, like ciprofloxacin and levofloxacin, also lost effectiveness, with resistance rates climbing steadily.
Salmonella Typhi: Rising Resistance in Foodborne Infections
Another concerning finding was that Salmonella typhi, which causes illnesses like diarrhoea and fever, showed over 95% resistance to fluoroquinolones. This makes it harder to treat foodborne infections and could increase the risk of outbreaks.
Threat to Critical Antibiotics
The report warns about the increasing resistance to CIAs and HPCIAs. These antibiotics are essential for treating severe human infections. The rise in resistance rates among key bacterial pathogens like E. coli, Klebsiella pneumoniae, and Staphylococcus aureus is a red flag for healthcare systems in India.
Need for Stronger Antibiotic Stewardship
The ICMR report calls for urgent action to combat the growing threat of antibiotic resistance. Stronger antibiotic stewardship, which means using antibiotics only when absolutely necessary, is crucial to slowing down this trend. If antibiotics continue to lose their effectiveness, common infections could become life-threatening once again.
Misuse in Agriculture
The misuse of antibiotics in agriculture also plays a role in this growing problem. The Centre for Science and Environment (CSE) has pointed out that many antibiotics from the critically important group are being used in food-producing animals like poultry, dairy, and fish. This misuse further contributes to antibiotic resistance, making it harder to treat infections in humans.
In summary, the 2023 ICMR report highlights an urgent health crisis: the rise of antibiotic resistance in India. With bacteria becoming resistant to critical antibiotics, there is a growing need for responsible use of these drugs in both healthcare and agriculture. Without swift action, treating infections may become much more difficult in the future.