Antimicrobial resistance tightens grip on Keralam, say latest report

Antimicrobial resistance in Keralam is no longer a problem of intensive-care units and tertiary hospitals. The State’s antibiogram, covering laboratory data from January 1 to December 31, 2025, released by the Kerala Antimicrobial Resistance Surveillance Network (KARS-Net), confirms what public health experts have been flagging for years — that drug-resistant bacteria are the norm now, not the exception in the State’s hospitals.

It also brings up the grim fact that the State is now confronting AMR at several levels, from highly resistant pathogens in intensive care units to community-acquired bacteria such as Shigella, which is now resistant to common antibiotics.

KARS-Net, being coordinated by the Department of Microbiology at Government Medical College, Thiruvananthapuram, since 2019 under Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP), now spans 59 government and private institutions, with data gathered from 55 laboratories across 14 districts.

The latest report analyses antimicrobial susceptibility data on 65,849 unique-patient isolates of nine priority pathogens in 2025. The bacteria most frequently isolated were familiar gut and hospital-acquired organisms: E. coli (41.2% of all isolates), Klebsiella species (25.8%), Pseudomonas species (10.8%), Staphylococcus aureus (8.9%) and Enterococcus species (8.6%). Of all isolates, 46% came from in-patients, 45% from outpatients, and 9% from ICU settings.

What the latest data show

The 2025 data reveal substantial resistance among some of the most important Gram-negative pathogens. Among E. coli isolated from blood, 73% were producing extended-spectrum beta-lactamases (ESBL- enzymes that decimate common penicillin and cephalosporin antibiotics) and 8% were resistant to Carbapenems, the “last-resort” class of antibiotics.

For Klebsiella species, the numbers were worse: 68% ESBL-positive and 43% Carbapenem-resistant in blood isolates, meaning nearly half of bloodstream Klebsiella infections may not respond to standard last-line therapy. Ciprofloxacin resistance was 62%.

Among blood isolates of Acinetobacter, which is a notorious ICU pathogen, Carbapenem resistance was 52%, while Pseudomonas species showed 20% Meropenem resistance.

AMR in Gram-negative pathogens are particularly concerning because these bacteria have an additional outer membrane and other multiple resistance mechanisms which can make already serious infections exceptionally difficult to treat, according to literature.

Gram-positive pathogens also offered a stark picture. Among Staphylococcus aureus isolated from blood, 33% were methicillin-resistant (MRSA), a slight uptick from the previous year. Enterococcus isolates from blood showed 4% resistance to vancomycin (VRE) and 1% to linezolid, broadly unchanged from last year

The report shows that Colistin, an older and more toxic antibiotic that is usually reserved for treating severe infections caused by highly-resistant Gram-negative bacteria, remains largely effective in Kerala, as of now.

“Colistin is a last-resort antibiotic and in the State, its overall resistance profile is 0.1% now. But over the last seven years, we find that Colistin resistance is also emerging and it is a cause for concern,” a senior public health expert said.

Comparing data from 2018 through 2025, the report finds that ESBL production and carbapenem resistance have broadly held steady at high levels over recent years, after both had climbed sharply from 2018 baselines.

Typhoidal Salmonella and Shigella, both linked to unsafe food and water, showed comparatively low resistance to first-line ampicillin (7-8%) but high resistance to ciprofloxacin — 55% in S. Typhi, 63% in S. Paratyphi and 93% in Shigella species — a dangerous signal that even community-acquired infections are no longer treatable with commonly prescribed antibiotics.

A model for the country

Seven years into its AMR containment strategy, Keralam has built an AMR surveillance system which is a model for the rest of the country. The network has expanded and has standardised its testing and reporting through WHONET software. It now feeds data into India’s national NCDC surveillance system and WHO’s Global Antimicrobial Resistance Surveillance System (GLASS).

However, wider surveillance does not seem to have converted to change in prescribing behaviour or people’s attitude towards antibiotic abuse, going by the high AMR levels. Targeted stewardship interventions to change prescribing behaviour and more community-level awareness and antibiotic literacy initiatives might be in order.

Published – September 20, 2026 04:14 pm IST