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NEW DELHI – Drug-resistant infections are associated with higher mortality and significantly greater treatment costs than infections caused by drug-sensitive bacteria, according to a major study conducted through the Indian Council of Medical Research (ICMR) antimicrobial resistance surveillance network.
The multicentre study, conducted across 20 tertiary-care hospitals in India between April 2022 and April 2025, analysed data from 159,336 hospitalised patients. Among them, 26,213 had confirmed Gram-negative bacterial infections, with 16,025 patients, or 61.1%, infected with bacteria resistant to carbapenem antibiotics.
The findings underline the growing health and economic burden of antimicrobial resistance (AMR) in India, where increasingly resistant bacteria can make serious infections harder to treat.
Drug-Resistant Infections Linked to Higher Mortality
The ICMR study found that patients infected with carbapenem-resistant bacteria faced a higher risk of death than patients infected with susceptible strains of the same bacteria.
The research examined four major Gram-negative pathogens: Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa.
For E. coli infections, mortality was 24.4% among patients with carbapenem-resistant infections, compared with 17.3% among those with susceptible infections. For K. pneumoniae, mortality stood at 31.2% in the resistant group versus 23.5% in the susceptible group.
The mortality gap was also observed for Acinetobacter baumannii and Pseudomonas aeruginosa.
Pseudomonas and E. coli Show Significant Risk Differences
The relative risk of death was particularly notable among patients infected with resistant strains.
According to the study, carbapenem-resistant E. coli was associated with a 41% higher risk of death compared with susceptible E. coli. For K. pneumoniae, the increase was 33%.
The corresponding increase was 16% for A. baumannii and 43% for P. aeruginosa.
These findings demonstrate why antimicrobial resistance is not simply a laboratory or surveillance issue. Resistant infections can directly affect clinical outcomes, particularly among hospitalised patients with serious bacterial infections.
Treatment Costs Can Be Up to Twice as High
The financial impact of drug-resistant infections was another major finding.
The study found that antibiotic treatment costs were approximately 1.1 to two times higher for carbapenem-resistant infections than for susceptible infections.
Importantly, the researchers noted that these figures covered antibiotic costs only. They did not include expenses such as hospital beds, diagnostic testing, doctors’ fees or supportive care.
This means the overall economic burden associated with resistant infections could be substantially greater once the full cost of hospitalisation is taken into account.
Carbapenem Resistance Is a Growing Concern
Carbapenems are important antibiotics used to treat severe bacterial infections, particularly when other treatments may no longer be effective.
The emergence of bacteria resistant to these medicines therefore creates a serious therapeutic challenge.
The ICMR study found that more than 61% of the confirmed Gram-negative infections included in the analysis were carbapenem-resistant, highlighting the scale of resistance among the hospitalised patients covered by the surveillance network.
When bacteria become resistant to commonly used antibiotics, physicians may have fewer effective treatment options and may need to rely on newer or more expensive medicines.
Bloodstream Infections Carry Particularly High Risks
The study also identified especially high mortality among patients with bloodstream infections caused by carbapenem-resistant non-fermenting bacteria.
Mortality in these cases reached approximately 46.4% to 50.8%, according to the research.
Such findings are particularly concerning because bloodstream infections can progress rapidly and may require immediate treatment.
The results reinforce the importance of rapid diagnosis, appropriate antibiotic selection and effective infection-control practices in hospitals.
Why Antimicrobial Stewardship Matters
The findings strengthen the case for better antimicrobial stewardship, which involves ensuring antibiotics are used appropriately and only when medically necessary.
Unnecessary antibiotic use can contribute to the development and spread of resistant bacteria. Appropriate prescribing, laboratory testing and monitoring can help healthcare professionals select effective treatments while reducing unnecessary exposure to antibiotics.
The ICMR has identified antimicrobial resistance as a major public-health challenge and has established its Antimicrobial Resistance Surveillance and Research Network to monitor resistance patterns and support evidence-based treatment strategies.
Infection Prevention Can Reduce the Burden
Antibiotic stewardship is only one part of the response to antimicrobial resistance.
Strong infection-prevention measures are equally important, particularly in hospitals where resistant organisms can spread between vulnerable patients.
Hand hygiene, environmental cleaning, appropriate isolation procedures and effective surveillance can help reduce transmission.
The ICMR study’s authors emphasised the need to strengthen surveillance, infection prevention and control, and access to effective therapies as part of the response to carbapenem-resistant Gram-negative infections.
The Economic Burden Extends Beyond Antibiotic Bills
The cost findings are important because the financial consequences of antimicrobial resistance extend beyond the price of medicines.
Resistant infections can require more complex treatment and may increase pressure on healthcare resources. Longer hospital stays, additional diagnostic procedures and intensive supportive care can add to the overall cost of managing a patient.
Earlier research among hospitalised patients in India has also found higher treatment costs and longer hospital stays among patients with resistant infections compared with those with susceptible infections.
Together, the evidence suggests that antimicrobial resistance represents both a medical and economic challenge.
India Faces a Growing AMR Challenge
India has a large burden of bacterial infections, making antimicrobial resistance an especially important public-health issue.
The latest ICMR findings provide patient-level evidence showing that resistance can translate into more deaths and higher treatment costs, rather than simply higher resistance rates in laboratory reports.
The study also demonstrates the value of multicentre surveillance because data from multiple hospitals can provide a broader picture of how resistant infections affect patients across different healthcare settings.
Need for Faster Diagnosis and Better Treatment
One of the key challenges in treating resistant infections is identifying the causative bacteria and their resistance profile quickly.
Delayed identification can make it more difficult to select the most effective antibiotic. At the same time, inappropriate or unnecessarily broad antibiotic treatment can contribute to further resistance.
Improving diagnostic capacity and ensuring timely access to effective medicines will therefore remain critical components of India’s AMR response.
Drug Resistance Is Both a Health and Cost Crisis
The latest ICMR study sends a clear warning: drug-resistant infections are not only harder to treat, but can also be more deadly and more expensive.
With carbapenem-resistant infections showing higher mortality across major Gram-negative pathogens and antibiotic costs reaching up to twice those associated with susceptible infections, the consequences of antimicrobial resistance are becoming increasingly difficult to ignore.
Strengthening surveillance, infection prevention, antimicrobial stewardship and access to effective treatments will be essential to reduce the impact of resistant infections.
For India, tackling antimicrobial resistance is no longer simply about protecting the effectiveness of antibiotics. It is also about saving lives, reducing healthcare costs and protecting the long-term resilience of the country’s health system.
