Superbugs—bacteria, fungi, viruses, or parasites resistant to all commercially available antimicrobials—are rapidly on the rise. Meanwhile, the development of new, effective drugs to combat them remains worryingly slow. Among these, bacteria dominate due to their extraordinary abilities to evolve rapidly and exchange resistance genes through horizontal gene transfer. Alarmingly, a World Health Organization (WHO) report found that deaths from antibiotic-resistant bacterial infections now surpass those caused by HIV/AIDS or malaria.
Hospitals: Ground Zero for Antimicrobial Resistance (AMR)
We now face a “post-antibiotic” era, where first-line drugs often fail to cure common infections. Hospitals are major hotspots for the emergence of resistance, as microbes constantly encounter antimicrobial agents in these settings. Overuse and misuse of antibiotics in clinical settings, livestock, and agriculture fuel this crisis. For example, when bacteria are frequently exposed to low doses of antibiotics—through waste in sewage or agricultural runoff—they adapt and survive. These resistant bacteria multiply and can even transfer their resistance genes to other, previously sensitive strains.
Colistin: Last Line of Defence Under Threat
Colistin, long considered a last-resort antibiotic against Gram-negative bacteria like Escherichia coli, has also begun to fail. As resistance grows against this reserve drug, healthcare systems face the grim possibility of losing their most potent weapons against severe infections.
How Hospitals Respond: Stewardship and Surveillance
To counter AMR, many hospitals implement antimicrobial stewardship programs. These initiatives aim to optimise antibiotic use by balancing the right drug, dose, duration, and route (oral or topical), while minimising resistance and toxicity.
As per the press release, hospitals routinely collect and analyse microbiological samples from high-risk areas such as operating rooms, OPDs, and inpatient wards. Based on this data, they create yearly antibiotic susceptibility profiles for key pathogens. These profiles guide the following year’s policy on preferred antibiotics for various infections.
For instance, in ocular infections, antibiotic choice and delivery method depend on the infection site—whether it’s on the eye’s surface or deeper within. The stewardship program categorises drugs based on effectiveness:
- First-line drugs kill less than 90% of bacteria in samples
- Second-line drugs, including reserve options like Colistin, are more effective but reserved for emergencies
Doctors must begin treatment with first-line options. If the patient fails to respond or the infection is severe, only then can clinicians escalate to second-line drugs. This careful tiered approach helps preserve the potency of critical antimicrobials.
Monitoring Compliance is Key
Robust stewardship isn’t enough unless hospitals audit their adherence to these guidelines. Regular checks ensure responsible prescribing and prevent unnecessary escalation to reserve antibiotics.
Infection Control: Simple Measures, Big Impact
Dr. Atul Gawande aptly remarked that medical success often hinges not on brilliant diagnoses, but on basic practices like hand hygiene. Effective infection control relies on disciplined handwashing, timely staff vaccination, proper handling of hospital linen, and regular cleaning of all contact surfaces. While simple, these practices are often the hardest to enforce, making ongoing staff education and training essential.
Safe Waste Disposal Prevents Environmental AMR Spread
Hospitals also contribute to environmental AMR through improper disposal of antibiotics. Discarded pills and expired medicines, if flushed into sewage, become breeding grounds for resistant microbes. Instead, hospitals must follow strict biomedical waste disposal protocols. Medicines are incinerated or autoclaved based on state and central pollution control board regulations, ensuring they don’t re-enter the environment.
The Wider AMR Challenge: A Shared Responsibility
Hospitals alone cannot stem the tide of AMR. Society’s broader overuse of antibiotics—in medicated soaps, over-the-counter drugs, and household cleaners—further contaminates our water systems. However, the most dangerous source is agriculture, aquaculture, and dairy, where unregulated antimicrobial use drives resistance at scale.
Conclusion: A Social Contract Against AMR
Combating AMR requires collective action. Doctors, patients, researchers, policymakers, and industries must come together to preserve our remaining effective treatments. Only through coordinated efforts can we restore balance and sustain our hard-won progress against infectious diseases.
Dr. Sanchita Mitra
Consultant Microbiologist,
L V Prasad Eye Institute