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 The Indian Council of Medical Research (ICMR) has released eighth detailed report from the ICMR AMR surveillance network. ICMR has been supporting the Antimicrobial Resistance Research & Surveillance Network (AMRSN) since 2013. This report presents data from January 1, 2024 to December 31, 2024.
The network systematically collects, analyses, and reports data on antimicrobial resistance (AMR) among six key pathogenic groups across India. The network labs undertake susceptibility testing as per the ICMR Standard Operating Practices for Bacteriology and Mycology.
This report provides valuable insights into national trends and resistance patterns, as well as the underlying mechanisms of resistance identified through genomic and whole-genome sequencing (WGS) analyses. Since the network collects data from tertiary care hospitals, the data presented in this report is not reflective of the community levels of AMR in the country and should not be extrapolated to community settings.
As per the findings of the report, the total number of culture-positive isolates studied during the year 2024 was 99,027.
Gram-negative bacteria (GNB) remained the most commonly isolated pathogens from most clinically relevant samples, like blood, urine, CSF, and respiratory tract samples, except for pus/exudate samples. Escherichia coli was the most commonly isolated pathogen, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus aureus.
Within healthcare-associated bloodstream infections (BSI), Gram-negative bacteria accounted for 72.1% of all BSI cases, 10.2% were due to fungal pathogens, and 17.7% were from Gram-positive pathogens.
Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa constituted nearly 80% of causative pathogens for Ventilator-associated Pneumonia (VAP), calling for caution around the empirical use of vancomycin, teicoplanin, and linezolid in most clinical situations.
As per the AMR trends reported, Escherichia coli and Klebsiella pneumoniae were the most commonly isolated pathogens. E. coli isolates showed an increase in susceptibility to ceftazidime, from 19.2% in 2023 to 27.5% in 2024. Susceptibility to amikacin, which had declined from 79.2% in 2017 to 68.2% in 2023, showed an increase to 72.5% in 2024. In contrast, a significant decline in susceptibility was observed for carbapenems — from 81.4% in 2017 to 62.7% in 2023 and a further decrease to 57.6% in 2024 for imipenem, and from 73.2% in 2017 to 66% in 2023 and to 62.9% in 2024 for meropenem.
K. pneumoniae showed reduced susceptibility, notably with piperacillin-tazobactam (falling from 42.6% in 2017 to 26% in 2024) and carbapenems (imipenem from 58.5% in 2017 to 31.2% in 2024, and meropenem from 48.1% in 2017 to 35.1% in 2024). K. pneumoniae also showed an increase in susceptibility to various antibiotics since 2023; cefotaxime, from 17.3% in 2023 to 20.3% in 2024; ceftazidime, from 18.1% in 2023 to 23.7% in 2024; amikacin from 34.5% in 2023 to 39.9% in 2024; ciprofloxacin from 17.1% in 2023 to 20.4% in 2024, and levofloxacin from 17.4% in 2023 to 24.8% in 2024.
As per clinical relevance findings of the report, among Enterobacterales, E. coli is the predominant pathogen isolated from the urine samples. Fairly good susceptibility was observed for nitrofurantoin and fosfomycin, and therefore, nitrofurantoin or single-dose fosfomycin remains the drug of choice for treating cystitis.
Ertapenem or amikacin to be used for the treatment of upper urinary tract infections (UTIs), febrile UTIs. The use of quinolones and third-generation cephalosporins should be avoided for these infections to prevent further resistance development.
Resistance to carbapenems in K. pneumoniae (a very important pathogen causing bloodstream infection) and other Enterobacterales is ever-increasing.
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