Antimicrobial resistance (AMR) is an urgent and escalating public health crisis, threatening to undo decades of medical progress. AMR, which occurs when bacteria evolve to resist the effects of antibiotics, poses a particularly severe challenge in India. A recent Lancet study highlighted the alarming fact that one-third of the 29.9 lakh (2.99 million) sepsis-related deaths in India in 2019 were linked to drug-resistant bacterial infections. Globally, projections suggest that by 2050, more than 39 million lives could be lost due to AMR, with South Asia, including India, facing the brunt of the crisis.
India’s AMR Crisis: The Role of Sepsis and Drug-Resistant Infections
Sepsis, a life-threatening condition triggered by the body’s extreme response to an infection, can rapidly lead to organ failure and death if not treated promptly. The treatment for sepsis often involves the use of antibiotics, but in India, growing bacterial resistance is making standard treatments less effective, complicating efforts to save lives. Of the 29.9 lakh sepsis deaths recorded in India in 2019, approximately 10.4 lakh (1.04 million) were linked directly to AMR, with 2.9 lakh (290,000) deaths directly attributed to it.
The misuse and overuse of antibiotics in India is a significant driver of AMR. Many patients use antibiotics without a doctor’s prescription, either by purchasing them over-the-counter or reusing leftover medications from past illnesses. Often, patients fail to complete their prescribed course, stopping treatment once symptoms subside, which allows bacteria to survive and adapt, eventually becoming resistant to the drugs. In addition, the lack of widespread diagnostic tools in hospitals and clinics means that broad-spectrum antibiotics are frequently prescribed without identifying the specific bacteria responsible for the infection, further fueling resistance.
The most common drug-resistant pathogens in India include Escherichia coli (E. coli), which causes gut infections, Klebsiella pneumoniae, known for causing pneumonia and urinary tract infections, and Acinetobacter baumannii, a pathogen often associated with hospital-acquired infections. These bacteria have become increasingly resistant to commonly used antibiotics, leaving doctors with fewer treatment options, especially in critical care settings.
A Global Health Challenge: AMR Projections and Trends
While the situation in India is dire, AMR is a global crisis. According to the Lancet study conducted by the Global Research on Antimicrobial Resistance (GRAM) Project, AMR-related deaths have been on the rise worldwide for decades, and without urgent action, the problem will only worsen. In 2021 alone, over 1.14 million deaths were directly caused by AMR, and by 2050, that figure is expected to climb to 1.91 million per year. In total, AMR is projected to play a role in 8.2 million deaths annually by mid-century.
South Asia, including India, is expected to bear a significant portion of the global AMR burden. Between 2025 and 2050, an estimated 11.8 million deaths across India, Pakistan, and Bangladesh will be directly linked to AMR, underscoring the urgent need for comprehensive interventions. Other regions, including southern and eastern Asia and sub-Saharan Africa, are also at high risk, as many of these areas already experience high rates of drug-resistant infections.
The study also highlights a worrying trend in older populations. While improvements in vaccination and hygiene have significantly reduced deaths related to infections in children under five, deaths due to AMR have increased by over 80% in individuals over 70 years old over the past three decades. By 2050, fatalities from AMR in this age group are projected to rise by 146%, from 512,353 to 1.3 million annually. This increase is attributed to the fact that older people are more vulnerable to infections and are more likely to require hospital care, where drug-resistant infections are more prevalent.
The Mechanisms Behind AMR: How Drug-Resistant Bacteria Emerge
Antimicrobial resistance emerges when bacteria are exposed to antibiotics but survive due to genetic mutations that make them less susceptible to the drug. Over time, these resistant bacteria multiply and spread, often in hospitals, nursing homes, and other healthcare settings where antibiotics are commonly used.
One of the deadliest forms of AMR involves Methicillin-resistant Staphylococcus aureus (MRSA), a bacteria that causes severe infections in hospitals and is resistant to many types of antibiotics. Globally, deaths linked to MRSA have more than doubled, rising from 57,200 in 1990 to 130,000 in 2021. In India, aminopenicillin-resistant E. coli is the leading cause of fatal drug-resistant infections, contributing to an estimated 6.8 lakh (680,000) deaths in 2019.
The problem extends beyond human healthcare. In industries such as aquaculture and livestock farming, antibiotics are routinely used to prevent disease and promote growth. These antibiotics can enter the human food chain, contributing to the spread of resistant bacteria through the consumption of contaminated food.
Addressing AMR in India: The Need for a Holistic Approach
Tackling AMR in India will require a comprehensive and multi-faceted strategy. First and foremost, there is an urgent need for better diagnostic tools to ensure that antibiotics are only prescribed when absolutely necessary and that the correct antibiotic is chosen based on the specific bacteria responsible for the infection. Without widespread access to diagnostic testing, doctors often resort to prescribing broad-spectrum antibiotics, which may not be effective and can contribute to resistance.
In addition to improving diagnostics, there is a need for greater public awareness about the dangers of antibiotic misuse. Public health campaigns should focus on educating the public about the importance of completing prescribed antibiotic courses and discouraging the use of over-the-counter antibiotics without a doctor’s supervision.
Healthcare institutions must also play a central role in the fight against AMR. Mandatory public reporting of healthcare-associated infections (HAIs) should be enforced in all accredited hospitals to improve transparency and accountability. A robust infection control framework, including strict hygiene protocols in hospitals and clinics, is crucial to reducing the spread of resistant bacteria, particularly in vulnerable settings like intensive care units.
At the policy level, investments in new antibiotics and point-of-care diagnostics are essential to stay ahead of evolving bacterial resistance. Without new treatments, doctors will have fewer options for combating life-threatening infections, and the consequences could be catastrophic. Equally important is the need for global cooperation to address the AMR crisis, as drug-resistant bacteria know no borders.
A Global Call to Action
AMR is not just a healthcare issue but a global security threat that requires immediate attention from governments, healthcare institutions, and international organizations. As world leaders convene at the upcoming United Nations General Assembly to discuss antimicrobial resistance, there is hope that renewed commitments will be made, including targets to reduce AMR deaths by 10% by 2030. However, achieving these goals will require coordinated action across multiple sectors, including human and animal health, agriculture, and environmental management.
With the stakes higher than ever, the time to act is now. Failure to curb the rise of antimicrobial resistance could lead to a future where routine infections once easily treated with antibiotics become untreatable, leading to a catastrophic loss of life and a healthcare system overwhelmed by incurable diseases. For India, where the burden of AMR is already disproportionately high, swift action is critical to safeguarding the health of future generations and preserving the effectiveness of life-saving antibiotics.
References:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01867-1/fulltext