A routine chest infection that should have been easily treatable has instead landed a patient in the intensive care unit, fighting for her life. The reason? None of the standard antibiotics are working against her infection, leaving doctors scrambling to find an effective treatment.
The Silent Health Emergency Unfolding in Indian Hospitals
This alarming scenario is becoming increasingly common in critical care units across India, according to medical experts. Dr. Rommel Tickoo, director of Internal Medicine at Max Healthcare, describes the situation as nothing short of a health emergency.
"With most bacteria becoming resistant to several commonly used antibiotics, treatment choices get limited and we are seeing more of such patients in our ICUs," Dr. Tickoo explains. The phenomenon behind this crisis is antimicrobial resistance (AMR) - the ability of microorganisms like bacteria, fungi and viruses to resist the effects of drugs designed to eliminate them.
Staggering Death Toll from Antibiotic Resistance
The human cost of this medical crisis is devastating. Recent data reveals that nearly 2.6 lakh deaths in India during 2021 were directly attributable to antimicrobial resistance. These are deaths that would not have occurred if the infections had responded to standard treatments.
Even more concerning, the total number of people who died with resistant infections that year reached 9.8 lakh, according to the Global Burden of Diseases study. Worldwide, antimicrobial resistance claims over a million lives annually, making it one of the most significant public health challenges of our time.
Dr. Kamini Walia, who heads ICMR's Antimicrobial Resistance Research and Surveillance Network, notes how the medical community's perspective has shifted dramatically. "Ten years ago, antimicrobial resistance was the problem of microbiologists. Now clinicians participate and help in implementing protocols to protect the antibiotics. This is because they face the brunt of it."
Changing Patterns in AMR-Related Mortality
The demographic profile of those most affected by antimicrobial resistance has transformed over the decades. While most AMR-associated deaths in 1990 occurred in children under five years old, the highest number of such deaths in 2021 was recorded among people above 70 years.
The severity of drug resistance directly correlates with mortality risk. A 2015 study across ten Indian hospitals found that people with multi-drug resistant infections were nearly twice as likely to die compared to those with drug-susceptible infections. For patients with extremely drug-resistant infections, this risk escalated to three times higher.
Prescription Practices Under Scanner
The roots of this crisis often begin with prescription patterns. A survey by the National Centre for Disease Control across 20 tertiary care hospitals revealed alarming trends in antibiotic usage.
The study found that approximately 75% of patients received antibiotic prescriptions. More concerning was that over half these prescriptions were not for treating existing infections but as prophylaxis to prevent potential infections - a practice generally discouraged by medical guidelines.
Additionally, 57% of antibiotics used belonged to the "watch group" - medications reserved for sicker patients that carry higher resistance potential. Perhaps most telling was that only 6% of antibiotic prescriptions were definitive treatments targeting diagnosed infections, while the overwhelming 94% were empirical prescriptions based on doctors' assessments of likely infections.
Comprehensive Approach Needed to Combat AMR
According to Dr. Walia, there is no single solution to this complex problem. "There is no magic bullet. There has to be good infection control in hospitals so that doctors don't have to compensate with prophylactic doses and more antibiotic prescriptions."
She emphasizes the need for better diagnostic facilities to reduce empirical treatment, rationalization of prescriptions to avoid multiple antibiotics, and the inclusion of infectious disease specialists in hospitals who can guide appropriate drug selection.
Dr. Chand Wattal, infectious disease specialist from Sir Ganga Ram Hospital, notes that infection control has gained importance in most hospitals since COVID-19. "People usually get resistant pathogens in the ICUs. Many hospitals, including newer government hospitals, are working towards better infection control driven by NABH and other quality assurance certification."
Hospitals are now monitoring indices like ventilator-associated, catheter-associated, or surgical site-related infections as performance metrics and setting targets for reduction. Healthcare systems and governments can combat AMR by improving infection prevention, control measures, and implementing surveillance to monitor antimicrobial use.
While some progress is visible - such as declining use of broad-spectrum antibiotics - medical experts caution that it will take considerable time to see significant impact on resistance patterns. The battle against antimicrobial resistance requires sustained effort from healthcare providers, policymakers, and the public alike.
