Why is it in News?
- New data from ICMR and tertiary hospitals show sharp rise in antimicrobial resistance (AMR) in ICUs across India.
- Nearly 2.6 lakh deaths in India in 2021 linked to AMR.
- Hospitals are overprescribing antibiotics; many prescriptions not based on microbiological evidence.
- ICUs reporting patients who no longer respond to even last-line antibiotics.
Relevance
GS 2 – Health
- Public health crisis due to AMR; hospital governance & regulation.
- Role of ICMR: surveillance, stewardship frameworks.
- Gaps in healthcare infrastructure, diagnostics, sanitation, infection control.
GS 3 – Science & Technology
- Microbiology basics: AMR, superbugs, ICU pathogens (Klebsiella, Acinetobacter).
- Need for diagnostic capacity, lab ecosystem strengthening, rapid tests.
GS 3 – Disaster Management / Public Health Emergency
- AMR as a slow-moving disaster → mortality burden (2.6 lakh deaths).
- ICU vulnerabilities, HAIs, systemic risk to healthcare systems.
What is Antimicrobial Resistance (AMR)?
- Microorganisms (bacteria, viruses, fungi) evolve to resist drugs meant to kill them.
- Caused by overuse/misuse of antibiotics in humans, animals, and environment.
- Leads to “superbugs” that standard drugs cannot kill → prolonged illness, mortality, higher costs.
- WHO lists AMR as top 10 global health threats.
Scale of the Crisis in ICUs
- ICUs facing multi-drug resistant and pan-drug resistant bacteria.
- Patients deteriorate because even carbapenems/colistin often ineffective.
- Hospitals report rising infections by Klebsiella, Acinetobacter, Pseudomonas—major ICU pathogens.
- Clinicians frequently forced to give multiple antibiotic combinations, sometimes blindly.
Why Antibiotic Misuse Is Rising ?
- Empirical prescribing: Doctors prescribe antibiotics without culture tests due to time constraints.
- Diagnostic gaps: Poor infection control, inadequate lab support in many hospitals.
- Patient pressure: Many expect antibiotics even for viral illnesses.
- Defensive medicine: Doctors act to avoid complications or litigation.
- Lack of stewardship: Only 20–30% hospitals have functional antimicrobial stewardship committees.
Key Findings From ICMR Data
- Resistance reported to even reserve/last-line antibiotics (carbapenems, colistin).
- Hospitals now using the “watch group” — antibiotics with higher resistance risk — more frequently.
- Only 6% of antibiotics prescribed in the survey were “definitive treatment” (infection confirmed).
- 94% prescriptions were empirical — based on symptoms rather than lab confirmation.
- Indicates structural diagnostic weakness in Indian hospitals.
ICU-Specific Challenges
- ICU patients have: ventilators, catheters, central lines → high risk of infection.
- Overcrowded ICUs → easier transmission of resistant bacteria.
- Higher antibiotic exposure → faster mutation and survival of resistant strains.
- Resistant bacteria persist in hospital environment (beds, instruments, staff clothing).
Consequences of Rising AMR
- Higher mortality: India among the highest AMR-related deaths globally.
- Increased treatment costs: longer ICU stays, expensive reserve drugs.
- Greater risk of healthcare-associated infections (HAIs).
- Reduced effectiveness of life-saving procedures: transplants, cancer therapy, surgeries.
Structural Issues Fueling the Problem
- Inadequate infection control: Poor sanitation, overcrowding, lack of dedicated IC personnel.
- Antibiotics available without prescription in many parts of India.
- Weak regulation of antibiotics in animal agriculture.
- Poor hand hygiene compliance among healthcare workers.
- Underinvestment in public hospitals → limited diagnostic capacity.
What ICMR Suggests ?
- Strengthen infection control so doctors are not forced to prescribe antibiotics “just in case”.
- Mandatory hospital antibiotic stewardship programmes.
- Ensure protocol-based prescribing and daily review of antibiotic need.
- Create AMR surveillance networks across states.
Diagnosis vs. Infection Control: The Core Problem
- Doctors often confuse colonization (bacteria present but not causing illness) with infection → unnecessary treatment.
- Without culture tests, symptoms alone often misleading.
- Real solution lies in good infection control, not more antibiotics.
Comparative Perspective
- Stuart Levy (AMR scholar): resistance rises wherever selective pressure is high → ICUs are ground zero.
- O’Neill Report (2016): warned AMR could cause 10 million deaths/year by 2050; India a major hotspot.
- Paul Farmer: inequality magnifies infectious disease crisis → seen clearly in India’s public hospitals.
Conclusion
- India’s ICUs are facing a public health emergency driven by antibiotic misuse and weak diagnostic systems.
- Over-prescription, poor infection control, and rising drug-resistant pathogens create a vicious cycle that standard antibiotics can no longer break.
- Strengthening diagnostics, stewardship, and infection control is essential to prevent AMR from becoming India’s next major health crisis.
