ICMR Study Finds Drug-Resistant Infections Raise Death Risk and Treatment Costs in India

A major study involving more than 26,000 patients across 20 tertiary-care hospitals in India has found that infections caused by carbapenem-resistant bacteria are associated with a higher risk of death and significantly higher antibiotic treatment costs.

The study, based on data collected between April 2022 and April 2025, analysed 159,336 hospitalised patients. Of these, 26,213 had confirmed infections caused by Gram-negative bacteria, including Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. Around 61.1% of these infections were resistant to carbapenem antibiotics.

Carbapenems are important antibiotics used to treat serious bacterial infections. Resistance to these medicines can leave doctors with fewer effective treatment options, particularly when patients are critically ill.

The researchers found that mortality was consistently higher among patients with carbapenem-resistant infections than among those infected with susceptible strains of the same bacteria. For E. coli, 24.4% of patients with resistant infections died, compared with 17.3% among those with susceptible infections. For K. pneumoniae, mortality was 31.2% in the resistant group compared with 23.5% in the susceptible group.

The difference was also seen with Acinetobacter baumannii and Pseudomonas aeruginosa. Mortality among patients with resistant infections was 37.9% and 28.9%, respectively, compared with 32.8% and 20.2% among patients with susceptible infections.

Bloodstream infections were particularly serious. Mortality among patients with carbapenem-resistant bloodstream infections ranged from 39.3% for E. coli to 50.8% for Acinetobacter baumannii. More than 85% of bloodstream infections involving the four bacteria were classified as healthcare-associated, highlighting the importance of infection prevention inside hospitals.

The financial burden was also higher. Antibiotic treatment costs for resistant infections were between 1.1 and two times higher than for susceptible infections. Average antibiotic costs for resistant E. coli infections were around ₹39,846 per patient, compared with ₹20,034 for susceptible infections. For Pseudomonas aeruginosa, the corresponding figures were approximately ₹66,599 and ₹48,392.

These figures only cover antibiotic costs. The researchers noted that expenses related to hospital beds, diagnostic tests, doctors’ fees and supportive care were not included. The actual cost of treating resistant infections can therefore be considerably higher.

The findings also point to the importance of faster diagnosis. Identifying the bacteria and determining its resistance pattern can help doctors choose appropriate treatment rather than relying unnecessarily on broad-spectrum antibiotics. Better infection-control practices can also reduce the spread of resistant organisms within healthcare facilities.

The researchers called for stronger antimicrobial stewardship, improved infection prevention and control, faster diagnostics and better access to effective treatments. They also cautioned that the study was conducted mainly in tertiary hospitals, which often treat referred and critically ill patients, so the mortality figures should not be interpreted as a measure of individual hospital performance.

For the wider public, the study is a reminder that antibiotic resistance is not simply a future health threat. It is already affecting treatment outcomes and healthcare costs in India. Responsible antibiotic use, completing prescribed courses and avoiding unnecessary antibiotic consumption remain important parts of limiting resistance.

The study adds to the evidence base being built through the Indian Council of Medical Research’s Antimicrobial Resistance Surveillance and Research Network, which monitors resistance patterns and supports research to guide antibiotic policies and stewardship programmes in India.