Antibiotics overuse led to 33% of sepsis deaths in India: Study

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Last Updated18/09/2024

When a 60-year-old patient with leukaemia was admitted to the emergency department with high fever and low blood pressure, he was immediately started on broad-spectrum antibiotics.

The recent case of a 60-year-old leukaemia patient whose condition worsened due to a drug-resistant Klebsiella infection underscores the severe impact of antimicrobial resistance (AMR).
Despite initial treatment with broad-spectrum antibiotics, the patient’s deteriorating health highlights the growing challenge of AMR in modern medicine.

Antimicrobial resistance occurs when bacteria and parasites evolve to resist drugs that previously effectively treated infections.
The Lancet study reports that in India alone, 60% of the 29.9 lakh sepsis deaths in 2019 were due to bacterial infections, with approximately 33.4% linked to AMR. Sepsis, a severe reaction to bacterial infections, can result in organ failure and death if untreated.

AMR is a major global health challenge and is expected to worsen. The Global Research on Antimicrobial Resistance (GRAM) Project forecasts that over 39 million people worldwide could die from antibiotic-resistant infections over the next 25 years.
The study analyzed trends across 22 pathogens and 11 infectious syndromes globally, including in India.
India faces a significant AMR burden, with E. coli, Klebsiella pneumoniae, and Acinetobacter baumannii being the most common resistant pathogens. Dr. Abdul Ghafur of Apollo Hospital, Chennai, attributes AMR to indiscriminate antibiotic use, inadequate diagnostics, and poor sanitation.

AMR arises from overuse and misuse of antibiotics, including:
Improper dosing and discontinuation of prescribed antibiotics.
Broad-spectrum antibiotics used without specific diagnostics.
Lack of laboratory infrastructure in resource-constrained settings.
Antibiotic use in industries, such as aquaculture, leading to environmental contamination.
Lower respiratory infections are the most common cause of sepsis deaths in India, with 27% of cases linked to AMR. In children under five, 3.25 lakh deaths in 2019 were due to bacterial infections, with streptococcus pneumoniae being particularly deadly.

Methicillin-resistant S. aureus (MRSA) saw a significant increase in deaths from 57,200 in 1990 to 130,000 in 2021. Among gram-negative bacteria, resistance to carbapenems has risen from 127,000 in 1990 to 216,000 in 2021.
In India, aminopenicillin-resistant E. coli poses a high fatal risk, with 6.8 lakh deaths associated with six major drug-resistant pathogens.

To combat AMR, the following measures are essential:
- Robust infection control frameworks and mandatory public reporting of healthcare-associated infections (HAIs).
- Investments in new antibiotics and rapid point-of-care diagnostics.
- Improved laboratory infrastructure, including mandatory culture facilities in district hospitals.
Dr. Kamini Walia from the Indian Council of Medical Research (ICMR) emphasizes ongoing government investments in laboratory infrastructure as a step towards addressing AMR.
The Summit of the Future may provide a platform for global dialogue on AMR, emphasizing the need for cohesive efforts to address this critical issue affecting global health and healthcare systems.