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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Burden of multi-drug-resistant organisms in a tertiary healthcare institute in North India: Implications for regional public health
Harshita Singh, Ananya Ashwairya Patel, Pradeep Pandy, Balram Ji Omar, Amber Prasad, Vanya Singh, Prakhar Sharma, Mukesh Bairwa, Rakesh Kumar Sihag, Ashutosh Tiwari, Deepak Rajput, Manish Kulshrestha, Sandeep Saini, Ajay Kumar, Bhaskar Sarkar, Bhanu Duggal, Ankit Agarwal, Nidhi Kaeley, Gaurav Dhingra, Prakash Mahala, Vishnu Yesodharan, Himanshu Chauhan, Deepa Kumari, Suman Choudhary, Ashok K Sharma, Rakhi Yadav, Prasan Kumar Panda
Harshita Singh, Ananya Ashwairya Patel, Pradeep Pandy, Mukesh Bairwa, Prasan Kumar Panda, Division of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh 249203, India
Balram Ji Omar, Amber Prasad, Vanya Singh, Department of Microbiology, All India Institute of Medical Sciences, Rishikesh 249203, India
Prakhar Sharma, Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh 249203, India
Rakesh Kumar Sihag, Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh 249203, India
Ashutosh Tiwari, Department of Neurology, All India Institute of Medical Sciences, Rishikesh 249203, India
Deepak Rajput, Manish Kulshrestha, Department of General Surgery, All India Institute of Medical Sciences, Rishikesh 249203, India
Sandeep Saini, Department of Nephrology, All India Institute of Medical Sciences, Rishikesh 249203, India
Ajay Kumar, Bhaskar Sarkar, Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh 249203, India
Bhanu Duggal, Department of Cardiology, All India Institute of Medical Sciences, Rishikesh 249203, India
Ankit Agarwal, Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rishikesh 249203, India
Nidhi Kaeley, Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh 249203, India
Gaurav Dhingra, Department of Hematology and Medical Oncology, All India Institute of Medical Sciences, Rishikesh 249203, India
Prakash Mahala, Vishnu Yesodharan, Himanshu Chauhan, Deepa Kumari, Suman Choudhary, Ashok K Sharma, Rakhi Yadav, Department of Nursing Services, All India Institute of Medical Sciences, Rishikesh 249203, India
Author contributions: Singh H, Patel AA, Pandy P, Omar BJ, Prasad A, Singh V, Sharma P, Bairwa M, Sihag RK, Tiwari A, Rajput D, Kulshrestha M, Saini S, Kumar A, Sarkar B, Duggal V, Agarwal A, Kaeley N, Dhingra G, Mahala P, Yesodharan V, Chauhan H, Kumari D, Chaudhary S, Sharma AK, and Yadav R were involved in the data collection, analysis, and writing of the draft; Panda PK was responsible for the conceptualization, investigation, methodology, resources, critical review, and approval; All authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The Institutional Ethics Committee approved the study, All India Institute of Medical Sciences, Rishikesh, India, No. 28/IEC/IM/NF/2023.
Informed consent statement: Considering a hospital-based retrospective study, informed consent was not required and waived by the Institutional Ethics Committee.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: It will be made available to others upon request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Prasan Kumar Panda, Additional Professor, Division of Internal Medicine, All India Institute of Medical Sciences, College Block, Rishikesh 249203, India.
motherprasanna@rediffmail.com
Received: March 18, 2025
Revised: April 29, 2025
Accepted: June 19, 2025
Published online: September 20, 2025
Processing time: 148 Days and 1.2 Hours
BACKGROUND
Antimicrobial resistance (AMR) is an escalating global health threat, disproportionately impacting low-income and middle-income countries like India. The rise of multidrug-resistant organisms (MDROs) complicates treatment, increases healthcare costs, and contributes to higher morbidity and mortality. In India, factors such as antibiotic misuse, over-the-counter availability, and self-medication have exacerbated this crisis. Despite the urgency, regional data on MDRO prevalence remains limited.
AIM
To assess the burden and distribution of MDRO infections identified at a tertiary healthcare institute in North India.
METHODS
This cross-sectional study analyzed inpatient data from All India Institute of Medical Sciences (AIIMS) Rishikesh using the E-hospital database from May 2021 to February 2024, except 2022. All inpatients with culture-confirmed MDRO infections were included. Patient charts and discharge summaries were reviewed. Data analysis was performed using Jamovi software, with descriptive statistics summarizing demographics. The χ² test was used to assess associations between MDROs and various factors. Ethical approval was obtained, and patient confidentiality was maintained.
RESULTS
This study included 820 participants having 1106 MDROs. The majority of patients were aged 35-64 years, with a male predominance (57.6%). Most cases were from Uttar Pradesh (49.1%) and Uttarakhand (47.6%), with Bijnor and Haridwar districts reporting the highest burden from their respective states. Klebsiella pneumoniae (K. pneumoniae) (30.6%), Acinetobacter baumannii (16.7%), and Escherichia coli (E. coli) (16.7%) were the most common MDROs. Urine was the most frequent sample type (51.0%), with K. pneumoniae as the leading pathogen. Infections varied significantly across departments (P < 0.001), with General Medicine and Surgery reporting the highest burden. E. coli and Klebsiella spp. were most prevalent in these departments respectively. MDRO prevalence fluctuated over time, with significant variations by quarter (P < 0.001). Following the second coronavirus disease 2019 wave, there was a rapid surge in MDROs, which stabilized after approximately three months. The overall mortality among patients harboring MDROs was 25.9%.
CONCLUSION
This study highlights the burden of MDROs among patients at AIIMS Rishikesh, with K. pneumoniae as the predominant pathogen. Strengthening antimicrobial stewardship and infection control measures is essential to combat rising AMR, with department-specific, and pathogen-specific stewardships.
Core Tip: The study assessed the burden of multidrug-resistant organisms (MDROs) in All India Institute of Medical Sciences Rishikesh from May 2021 to February 2024, except 2022. Klebsiella pneumoniae (30.6%) was the most common MDRO, with urine as the predominant sample type (51.0%). The highest burden was observed in the General Medicine and Surgery Departments, with significant quarterly variations (P < 0.001). Uttar Pradesh and Uttarakhand contributed the most cases, particularly from Bijnor and Haridwar districts. There was post-corona virus disease surge of MDROs and one-quarter died. Strengthening antimicrobial stewardship and infection control is crucial to curb antimicrobial resistance.
