Patients with infections resistant to carbapenem -- a powerful antibiotic often used as a last resort -- are associated with a higher risk of mortality than susceptible infections across major pathogens, according to research published in The Lancet Regional Health Southeast Asia. Researchers, including those from the Indian Council of Medical Research in New Delhi, studied nearly 1.6 lakh patients hospitalised across 20 tertiary care centres in India, of which 17.1 per cent were microbiologically confirmed and 16.4 per cent of the total had a gram-negative bacterial infection.

Specific types of bacteria having a protective outer shell that blocks common drugs can cause a gram-negative bacterial infection. The germs can easily fight off standard antibiotics.

More than 60 per cent of patients with gram-negative bacterial infection were found to be resistant to carbapenem.

In-hospital mortality was higher among patients with carbapenem-resistant infections, compared to those with carbapenem-sensitive infections, even as the typical hospital stay between the two groups were found to be comparable.

Antibiotic resistance occurs when microbes become immune to the very drugs designed to kill them.

"Our findings suggest that CR (carbapenem-resistant) gram-negative infections are associated with (a) high mortality and cost of therapy in tertiary care hospitals in India," the authors wrote.

Previous studies have identified CR gram-negative bloodstream infections as a major contributor to mortality, with a disproportionately high burden in South Asia, including India, the researchers said.

They added most studies from India have reported isolate-level microbiological data and that they did not identify a multi-centre study assessing burden, treatment modalities and mortality associated with a CR gram-negative infection.

The study found that mortality was higher across all the CR group pathogens, compared to susceptible group. Major pathogens studied included E. coli, K. pneumoniae and A. baumannii -- all are dangerous gram-negative bacteria.

The researchers said the evidence indicates that CR gram-negative infections are associated with an excess mortality, a prolonged hospitalisation, and increased treatment costs in India.

The findings underscore the urgent need to strengthen integrated AMR surveillance that links microbiological data with clinical outcomes, they said.

The team said there is also a critical need to expand infection prevention and control practices and promote a rational use of antibiotics.

In parallel, improving access to timely diagnostics and effective, affordable novel antimicrobials will be essential to improve outcomes and reduce the economic burden of these infections for patients, they said.

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