AIIMS Delhi Takes the Lead in Combating Antimicrobial Resistance in India
In a critical move to address one of the most pressing public health challenges of our time, the All-India Institute of Medical Sciences (AIIMS) in Delhi is at the forefront of the fight against antimicrobial resistance (AMR). This global threat, where microorganisms evolve to survive medicines designed to eliminate them, is projected to cause millions of deaths worldwide by 2050. India, bearing a significant burden with nearly 3 lakh deaths linked to AMR in 2019, is witnessing a surge in antibiotic consumption, making this initiative more urgent than ever.
The Growing Crisis of AMR in India
A recent case at AIIMS Delhi highlighted the severity of the issue. A 50-year-old man, never previously hospitalized, presented with symptoms of meningitis. Initial tests confirmed a bacterial infection, but further analysis revealed resistance to penicillin, a commonly used antibiotic. Dr. Bimal Kumar Das, professor and head of microbiology at AIIMS Delhi, expressed surprise, noting that such cases are becoming increasingly common across India. AMR has emerged as a serious threat, with drug-resistant infections making common ailments like pneumonia and urinary tract infections harder to treat.
Prime Minister Narendra Modi has flagged AMR as a growing national concern, prompting AIIMS Delhi to be designated as an Infectious Disease Research Diagnostic Laboratory (IRDL) centre and the nodal coordinating centre for the Antimicrobial Resistance Surveillance Network (AMRSN). The institute is currently running around 15 research projects focused on understanding resistance patterns, improving diagnosis, and promoting rational antibiotic use.
Key Strategies to Slow Down AMR
Reducing Blind Antibiotic Use: A major driver of AMR is the empirical use of antibiotics, often started before identifying the causative pathogen. Dr. Hitender Gautam, professor of microbiology at AIIMS Delhi, explains that while this approach is sometimes necessary in critical patients, it can lead to prolonged unnecessary antibiotic use. AIIMS studies aim to shorten this uncertainty window by enhancing diagnostic speed and accuracy, allowing for a quicker shift from broad-spectrum to targeted therapies.
Preventing Sepsis Early: Sepsis, a life-threatening response to infection, is a key focus area. Dr. Gautam's team is working on identifying site-specific biomarkers for bacteremia, where bacteria enter the bloodstream. Early detection can determine whether antibiotics are needed, avoiding unnecessary use. Additionally, research is addressing gaps in sepsis care, such as negative test results despite ongoing infections, by developing enhanced detection methods.
Improving Diagnosis for Specific Infections:
- Bacterial Meningitis: Research includes biomarker-based diagnostics and methods to detect viable but non-culturable bacteria, helping identify pathogens and avoid multiple unnecessary antibiotics.
- Diarrhoeal Infections: Misdiagnosis often leads to overtreatment. Specialized molecular tests are being emphasized to differentiate strains of Escherichia coli that cause diarrhea from normal gut bacteria.
- ESKAPE Pathogens: Highly resistant bacteria like Klebsiella pneumoniae are becoming common in India. Dr. Gautam is identifying novel DNA and RNA signatures to rapidly detect resistance patterns, aiding in effective drug selection.
- Urinary Tract Infections (UTIs): Dr. Sarita Mahapatra notes that UTIs are frequently misdiagnosed, leading to antibiotic misuse. AIIMS is exploring conditions like asymptomatic bacteriuria, which does not require treatment, to reduce unnecessary antibiotic prescriptions.
Innovative Approaches and New Antibiotics
AIIMS is exploring cutting-edge therapies, such as CRISPR-Cas9–based gene-editing to target resistant E. coli by removing resistance genes while preserving normal gut bacteria. Researchers are also generating India-specific data on newly approved antibiotics like Eravacycline and Omadacycline, building evidence on their performance against highly-resistant Indian pathogens to support rational prescribing.
Beyond antibiotics, quorum sensing inhibitors are being studied. These compounds disrupt bacterial communication systems, preventing coordinated harmful effects like biofilm formation. Compounds such as furanone and gallium nitrate have shown promising results in inhibiting this process.
Advances in Drug-Resistant Tuberculosis
Tuberculosis remains a major challenge, especially with multidrug-resistant strains. Dr. Urvashi B Singh highlights the BPaL-M regimen, which combines bedaquiline, pretomanid, linezolid, and moxifloxacin, as a breakthrough. This treatment shortens therapy from up to 18 months to six months with success rates above 90%. Genomic tools like next-generation sequencing are routinely used at AIIMS to rapidly identify drug resistance, enabling tailored treatment early on.
The Importance of Infection Control
Experts stress that research alone is insufficient. Resistant bacteria often emerge in intensive care units before spreading to the community. Dr. Gautam emphasizes that weak hospital infection control can undermine AMR efforts. Strict cleaning, disinfection, hand hygiene, and antimicrobial stewardship are crucial. Precise diagnosis and targeted therapy remain the strongest tools in this fight.
Only through a multi-pronged approach—combining early diagnosis, targeted therapy, innovation, and strict infection control—can India hope to slow the rise of superbugs and safeguard public health for future generations.
