How AIIMS is leading the fight against superbugs

AMR has emerged as one of the most serious public health threats globally. Drug- resistant infections are projected to cause 10 million deaths worldwide by 2050. India already bears one of the heaviest burdens, with an estimated 2.97 lakh deaths linked to AMR in 2019. Despite this, the country re-mains among the world’s largest consumers of antibiotics, with sales spiralling.

At AIIMS Delhi, tackling AMR has become a priority. The institute is currently running around 15 research projects focussed on understanding resistance patterns, improving diagnosis and promoting rational antibiotic use.

With Prime Minister Narendra Modi flagging AMR as a growing national threat — warning that common infections such as pneumonia and urinary tract infections are becoming harder to treat — AIIMS Delhi has been designated as an Infectious Disease Research Diagnostic Laboratory (IRDL) centre. It also serves as the nodal coordinating centre for the Antimicrobial Resistance Surveillance Network (AMRSN). “The focus is on early diagnosis, targeted therapy and strong hospital infection control,” says Dr Das.

The growing resistance of the typhoid-causing Salmonella typhi to antibiotics is a serious concern, he adds. AIIMS is using advanced genetic testing to study how it is spreading across north India.

Reducing blind antibiotic use

A major driver of AMR is the blind or empirical use of antibiotics, often started before doctors know which pathogen is causing an infection. Dr Hitender Gautam, professor of microbiology at AIIMS Delhi, explains that this approach is sometimes unavoidable, especially in critical patients. “We begin empirical therapy based on the most likely cause. But if we cannot identify the organism later, antibiotics continue longer than necessary,” he says. Many AIIMS studies are aimed at shortening this window of uncertainty by improving diagnostic speed and accuracy, allowing doctors to shift from broad-spectrum antibiotics to targeted treatment sooner.

Preventing sepsis early

One key area of focus is sepsis, a life-threatening condition triggered by the body’s overwhelming response to infection. If not detected early, sepsis can rapidly lead to organ failure and death. Dr Gautam’s team is working on identifying site-specific biomarkers for bacteremia, a condition where bacteria enter the bloodstream and can trigger sepsis. “If we can quickly determine whether bacteremia is present, we will know whether antibiotics are required,” he says. “If there is no bacteremia, unnecessary antibiotic use can be avoided.”

Another study addresses a common gap in sepsis care: negative test results despite ongoing infection. “When no pathogen is detected, we cannot move to targeted therapy and empirical antibiotics continue for too long,” Dr Gautam explains. Enhanced detection methods are being developed.

Improving diagnosis

Bacterial meningitis is another medical emergency where immediate antibiotic treatment is critical. However, early antibiotic use can make it difficult to identify the causative organism later. Dr Gautam’s team is researching biomarker-based diagnostics and methods to detect viable but non-culturable (VBNC) bacteria — organisms that are alive but cannot be grown in standard laboratory cultures. “If we can detect or revive these bacteria, we can identify the pathogen and avoid using multiple unnecessary antibiotics,” he says.

Not all diarrhoeal infections are alike, and misdiagnosis often leads to overtreatment. Certain strains of Escherichia coli cause diarrhoea by producing toxins or invading the intestinal lining but diagnosing them requires specialised molecular tests. “E. coli normally lives in the gut. Without proper testing, we may treat patients unnecessarily,” Dr Gautam explains.

Of particular concern are ESKAPE pathogens — highly resistant bacteria such as Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa — which are increasingly becoming common in India. Dr Gautam is identifying novel DNA and RNA signatures that can rapidly detect resistance patterns, helping clinicians choose the most effective drugs.

According to Dr Sarita Mahapatra, professor of microbiology at AIIMS Delhi, urinary tract infections are among the most common infections becoming drug-resistant due to antibiotic misuse. “UTIs are often mild but antibiotics become a double-edged sword when used without proper diagnosis,” she says. Many patients receive antibiotics even when infection is not clearly established, or when bacteria are present without symptoms — a condition known as asymptomatic bacteriuria (presence of bacteria in urine) that does not require treatment. AIIMS is also exploring innovative approaches such as CRISPR-Cas9–based gene-editing therapy to target resistant E.coli, removing resistance or virulence genes while preserving normal gut bacteria.

Testing new antibiotics

Researchers are busy generating India-specific data on newly approved antibiotics, including Eravacycline, Omadacycline, Plazomicin and Sulbactam/Durlobactam. “Most existing data comes from outside India. We are building evidence on how these drugs perform against highly-resistant Indian pathogens, which will support rational prescribing,” says Dr Gautam.

Beyond antibiotics, researchers are exploring quorum sensing inhibitors — compounds that disrupt bacterial communication systems. Quorum sensing (QS) is a bacterial communication system where cells release and detect chemical signals to sense their population density, allowing them to coordinate group protective behaviour like forming a biofilm to shield themselves. “It is like a bacterial roll call to ensure actions are taken collectively. If we inhibit this, they cannot coordinate their harmful effects,” Dr Gautam explains, saying compounds like furanone and metal-based agents such as gallium nitrate have shown promising results.

Experts stress that research alone is not enough. Resistant bacteria often emerge in intensive care units, where antibiotic use is high, before spreading to wards and the community. “If hospital infection control is weak, AMR cannot be controlled,” says Dr Gautam. He emphasises strict cleaning, disinfection, hand hygiene and antimicrobial stewardship. “Precise diagnosis and targeted therapy remain our strongest tools.”

Advances in drug-resistant TB

Tuberculosis remains a major public health challenge, particularly with the rise of multidrug-resistant TB. Dr Urvashi B Singh, professor of microbiology at AIIMS Delhi, says the BPaL-M regimen, which combines bedaquiline, pretomanid, linezolid and moxifloxacin, has been a breakthrough. “Earlier treatments could last up to 18 months. BPaL-M shortens therapy to six months with success rates above 90 per cent,” she says. Genomic tools such as next-generation sequencing are now routinely used at AIIMS to rapidly identify drug resistance, allowing doctors to tailor treatment early. “What began as research is directly improving patient care,” Dr Singh adds.

Only this multi-pronged approach of early diagnosis, targeted therapy, innovation and strict infection control can slow the rise of superbugs in India.