What Are Superbugs? The Bacteria Behind India's Antibiotic Resistance Crisis, Explained

Superbugs, bacteria that no longer respond to standard antibiotics, aren't just a future threat. They are already here, and India appears to be at the epicentre. A new large-scale, multinational study released recently in The Lancet eClinical Medicine found that roughly 83% of Indian patients undergoing a common endoscopic procedure carried at least one multidrug-resistant organism (MDRO). This alarming figure dwarfs comparable rates in Italy, the United States and the Netherlands. It signals that antibiotic resistance is not just a hospital ICU problem. It is already embedded deeply in Indian communities and health-care routines, and the results can be devastating.

With resistant infections now jeopardising routine medical procedures and outcomes, understanding what superbugs are, why India faces such high prevalence, and which pathogens drive this crisis is urgent. So, here's a closer look at the phenomenon of superbugs, key pathogens in the Indian context, root causes of India's particular vulnerability and the actions needed now.

Defining "Superbugs"

In essence, a "superbug" is a bacterium that has acquired resistance to one or more classes of antibiotics that were once reliably effective. Mechanisms include production of enzymes (e.g., carbapenemases), altered drug targets, efflux pumps and changes in cell permeability. Once bacteria become resistant to multiple antibiotic classes, available therapeutic options shrink dramatically.

The recent Lancet study exploited screening of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), a routine procedure, to show how widely MDROs are present in Indian patients even before major surgery.

Also Read: India At The Epicentre Of Superbug Explosion, Antibiotic Resistance Crisis: Lancet Study

Which Superbugs Are The Biggest Culprits In India?

Several resistant pathogens dominate the Indian burden:

• Enterobacterales, especially Klebsiella pneumoniae and Escherichia coli: These are major causes of urinary tract, bloodstream and hospital-acquired infections. The new study found that around 70.2% of Indian patients carried ESBL-producing bacteria.
• Carbapenem-resistant Gram-negatives (CRGNs): India's rate of carbapenem-resistance in certain pathogens was around 23.5% in the study, meaning even last-line drugs may be ineffective.
• Acinetobacter baumannii and Pseudomonas aeruginosa: These are notorious in ICUs for being extensively drug-resistant and causing ventilator-associated pneumonia. Surveillance in India shows extremely high resistance rates in these species.
• Staphylococcus aureus (MRSA - methicillin-resistant Staph. aureus): A longstanding problem in surgical sites and hospital infections.

These organisms, often grouped under the acronym "ESKAPE" (Enterococcus, Staph. aureus, Klebsiella, Acinetobacter, Pseudomonas, Enterobacter), represent the core of the antibiotic-resistance challenge. India's unusually high carriage and infection rates of these pathogens amplify risk across hospital and community settings.

Why Is India In Superbug Crisis Mode?

Several interlocking factors contribute to India now being termed the "epicentre of the superbug crisis":

• Over-the-counter access and misuse: Antibiotics are often used without prescriptions, for viral illnesses or inadequate courses. The study authors point to widespread misuse in human, animal and agricultural settings as key drivers.
• Weak diagnostic infrastructure: Without routine culture and sensitivity tests, empiric broad-spectrum antibiotics become the norm, fuelling selection pressure for resistance.
• Infection-control and sanitation gaps: Overcrowded hospitals, inconsistent hygiene, poor water/sewage management and antibiotic-laden effluents all support transmission of resistant organisms.
• Environmental and "One Health" spill-over: Resistant bacteria circulate between humans, animals and the environment. The study emphasises that the problem is no longer confined to hospitals, community carriage levels are extremely high even in younger age groups.

The Human And Health-System Cost Of The Superbug Crisis

The consequences of the current antibiotic resistance crisis are severe. The Indian study offers a stark patient-level example: Two individuals undergoing the same procedure, one carrying no MDRO, the other carrying resistant bacteria, had dramatically different outcomes.

Resistant infections lead to longer hospitalisations, more intensive care, usage of more expensive, and often more toxic, antibiotics, and higher mortality. Global modelling (e.g., the GRAM project) estimated that tens of thousands of deaths in India are already linked to resistant bacterial infections.

Also Read: WHO Raises Alarm Over Antibiotic Resistance: Why India Is Especially Vulnerable

What Must Be Done: Urgent Action

Given the state of antibiotic resistance in India, here are some steps for clinicians, policymakers and public to take.

• Strengthen antimicrobial stewardship programmes: culture-based prescribing, de-escalation protocols, stewardship alerts.
• Ramp up screening of high-risk patients (pre-procedure, ICU admissions) for MDRO carriage.
• Improve infection-control practices like hand-hygiene, environmental cleaning, isolation of carriers.

• Enforce stricter prescription-only antibiotic sales, curb over-the-counter use.
• Regulate veterinary and agricultural antibiotic use under a "One Health" framework.
• Expand surveillance networks (ICMR AMRSN, NCDC) and invest in rapid diagnostics.
• Launch public-education campaigns on the dangers of self-medication, incomplete courses and antibiotic misuse.

• Do not demand antibiotics for viral illnesses (colds, flu).
• Complete the full antibiotic course when prescribed, not more, not less.
• Maintain hand-hygiene, ensure vaccinations are up-to-date, practise safe food and sanitation.
• Support hospital safety: Ask if appropriate culture tests have been done, ask about surgical prophylaxis protocols.

Resistance evolves, but containment is still possible. The new study reinforces that India can't wait. Antibiotic resistance has moved into the mainstream. With high carriage rates, every hospital admission becomes a potential reservoir event; every surgery or procedure becomes higher risk. Policymakers speak of "turning the tide" but the window is closing. If appropriate antibiotic use, better diagnostics and infection-control aren't scaled rapidly, we risk losing the power of many first-line antibiotics for common infections, reversing decades of medical progress.

Disclaimer: This content, including advice, provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.