An ICMR 20-hospital study (Lancet Regional Health – Southeast Asia) of 159,336 inpatients (Apr 2022–Apr 2025) found >60% of Gram-negative infections (E. coli, Klebsiella, Acinetobacter, Pseudomonas) were carbapenem-resistant; 85–95% were healthcare-associated.

Resistant cases had higher death risk (relative 16% to 43%) and mortality of 24–38% overall, 46–51% in carbapenem-resistant Acinetobacter/Pseudomonas/Klebsiella bloodstream infections; antibiotic costs 1.1–2× higher and E. coli stays ~23 vs ~18 days.

Authors urge outcome-linked surveillance, infection control, stewardship, timely diagnostics, and access to newer drugs—not resistance maps alone—while noting tertiary referral mix means these rates are not a hospital-performance scorecard.

A 20-hospital, 3-year ICMR study of over 150,000 patients finds that carbapenem drug-resistant infections are driving up both deaths and treatment costs

A large multi-centre study of over 150,000 patients in India’s 20 tertiary-care hospitals has put a stark number on one of the top ten global health threats today: Antimicrobial Resistance (AMR). AMR happens when infections easier to treat earlier become difficult (or impossible) to treat due to disease-causing microbe (such as bacteria, virus, fungi, parasite) becoming drug resistant.

The findings offer one of the clearest multi-centre pictures yet of the clinical and economic burden when common Gram-negative bacteria become resistant to carbapenem antibiotics.

And the message is blunt: AMR is not simply making infections harder to treat. It is translating into more deaths and substantially higher treatment costs.

Researchers compared outcomes among patients infected with four major Gram-negative pathogens – Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa) – looking specifically at infections that were drug-resistant or susceptible to carbapenem antibiotics. Carbapenem antibiotics are a powerful group of broad-spectrum antibiotics, upon which clinicians have traditionally relied on when infections caused by Gram-negative bacteria become resistant to other drugs. Resistance to these medicines therefore leaves doctors with fewer therapeutic options.

E. coli is a common cause of urinary and bloodstream infections; K. pneumoniae can cause pneumonia, urinary infections and sepsis; A. baumannii is particularly associated with critically ill hospital patients; and P. aeruginosa can cause severe infections in people with prolonged hospital exposure or underlying illness.

The study authored by Dr Kamini Walia, Dr Sonam Vijay, Dr Nitin Bansal, et al, published inThe Lancet Regional Health – Southeast Asia (Volume 53, October 2026), analysed data from 20 tertiary-care hospitals across India between April 2022 and April 2025. Dr Kamini Walia serves as a senior scientist at Indian Council of Medical Research (ICMR), heads its Descriptive Research Division and leads ICMR on Antimicrobial Resistance (AMR).

Each of the 20 participating hospitals was required to designate a minimum of 150 inpatient beds for Antimicrobial Resistance (AMR) surveillance activities, including at least 50 intensive care unit (ICU) beds and 100 ward beds.

“All patients were followed up until their final clinical outcome (discharge from the hospital or death),” notes the study.

“Carbapenem drug-resistant infections caused substantially higher mortality and treatment costs than susceptible infections. Mortality was particularly high in bloodstream........

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