Drug-resistant bacterial infections are emerging as a major burden for India’s healthcare system, with patients facing higher mortality, longer hospital stays and substantially greater treatment costs, according to a new ICMR-led study conducted across 20 tertiary-care hospitals.
Study analyses over 1.6 lakh hospitalised patients
Published in The Lancet Regional Health–Southeast Asia, the study examined around 1.6 lakh hospitalised patients between April 2022 and April 2025. Researchers identified 26,213 patients with infections caused by four major Gram-negative bacteria E. coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa.
More than 60% infections found to be carbapenem-resistant
The study found that 61.1% of the identified infections were resistant to carbapenems, antibiotics that have traditionally been used as a last-resort treatment for severe bacterial infections.
Researchers warned that the increasing prevalence of resistance is making serious infections harder and more expensive to treat.
Resistant infections associated with higher mortality
Mortality was consistently higher among patients infected with drug-resistant strains compared with those carrying susceptible strains.
- K. pneumoniae: 31.2% vs 23.5%
- E. coli: 24.4% vs 17.3%
- A. baumannii: 37.9% vs 32.8%
- P. aeruginosa: 28.9% vs 20.2%
The findings highlight the serious clinical consequences of antimicrobial resistance, particularly among hospitalised and critically ill patients.
Treatment costs rise with resistance
Patients with resistant infections also required more expensive antibiotic treatment. According to the study, antibiotic treatment costs were 1.1 to 2 times higher for resistant infections.
The average costs were:
| Bacteria | Resistant infection | Susceptible infection |
|---|---|---|
| E. coli | $420 | $211 |
| K. pneumoniae | $587 | $505 |
| A. baumannii | $655 | $436 |
| P. aeruginosa | $702 | $510 |
Longer hospital stays add to the burden
Drug-resistant infections were also linked to prolonged hospitalisation. Patients with resistant E. coli infections, for example, stayed in hospital for an average of 23.1 days, compared with 17.8 days among those with susceptible infections.
Doctors noted that identifying the organism and its resistance pattern can take several days, although molecular diagnostic technologies can help speed up the process.
ICMR calls for prevention and responsible antibiotic use
ICMR senior scientist Dr Kamini Walia, an author of the study, said antimicrobial resistance is already having a significant impact on Indian patients. She emphasised that tackling the problem requires more than developing stronger antibiotics.
The researchers called for stronger AMR surveillance, infection-control practices, antimicrobial stewardship and timely diagnostics, along with improved access to effective medicines.
Study limitations noted
The researchers cautioned that the analysis was based on patients treated at tertiary-care hospitals, where critically ill and referred patients are more likely to be concentrated. Therefore, the findings should not be interpreted as a measure of the performance of individual hospitals.
