Modgil Vinay, Sahay Sundeep, Taneja Neelam, Qayyumi Burhanuddin, Singh Ravikant, Mukherjee Arunima, Bhoi Bibekananda, Arora Gitika
Society for Health Information Systems Programmes (HISP India), New Delhi 110025, India.
Department of Informatics, University of Oslo, 0373 Oslo, Norway.
Antibiotics (Basel). 2025 Jul 5;14(7):684. doi: 10.3390/antibiotics14070684.
Antimicrobial resistance (AMR) poses a significant threat to public health, especially in low- and middle-income countries (LMICs), where surveillance infrastructure is underdeveloped. Bihar, India's third most populous state and one of its least-resourced states, has remained largely absent from national AMR monitoring initiatives. This study aimed to characterize the AMR infection landscape across five public tertiary care hospitals in Bihar over three years (2022-2024) and to assess the feasibility of integrating digital workflows for real-time microbiological reporting. Standardized antimicrobial susceptibility testing (AST) was performed on >48,000 urine, pus, and blood samples using CLSI guidelines. Facility-level data were digitized into an open-source AMR reporting system, enabling automated antibiogram generation. The findings revealed substantial resistance: high resistance to beta-lactams, carbapenems, and fluoroquinolones across pathogens. For instance, sensitivity to nitrofurantoin varied from 86.5% at NMCH (Patna) to 44.7% at JLNMCH (Bhagalpur), while cephalosporin sensitivity in spp. dropped below 2% in several hospitals. MRSA prevalence exceeded 65% in two facilities, far above the national average of 47.8%. Digital integration led to a four-fold increase in culture testing in all facilities and improved data completeness and turnaround times. Spatial analysis and microbiology laboratory assessment revealed significant geographic disparities in diagnostic access, with facilities in remote districts facing delays of over four hours for basic testing. Our study is the first study from India to create such a broad, facility-associated AMR picture over time at a state level. Policy implications include the need for a state-level AMR surveillance dashboard, alignment of procurement with facility-specific resistance patterns, and routine stewardship audits. Clinically, this study demonstrates the utility of localized antibiograms for guiding empirical therapy in resource-limited settings. This study provides a scalable framework for embedding AMR surveillance into routine health system workflows in LMICs.
抗菌药物耐药性（AMR）对公共卫生构成重大威胁，尤其是在低收入和中等收入国家（LMICs），这些国家的监测基础设施欠发达。比哈尔邦是印度人口第三多的邦，也是资源最匮乏的邦之一，在国家抗菌药物耐药性监测倡议中基本没有参与。本研究旨在描绘比哈尔邦五家公立三级护理医院在三年（2022 - 2024年）期间的抗菌药物耐药性感染情况，并评估整合数字工作流程以进行实时微生物报告的可行性。使用美国临床和实验室标准协会（CLSI）指南，对超过48000份尿液、脓液和血液样本进行了标准化抗菌药物敏感性测试（AST）。机构层面的数据被数字化录入一个开源抗菌药物耐药性报告系统，实现了自动抗菌谱生成。研究结果显示出大量耐药情况：多种病原体对β - 内酰胺类、碳青霉烯类和氟喹诺酮类药物耐药性高。例如，呋喃妥因的敏感性在那烂陀医学院医院（巴特那）为86.5%，在贾耶普拉卡什·纳拉扬医学院医院（巴格布尔）为44.7%，而在某些医院，肺炎克雷伯菌对头孢菌素的敏感性降至2%以下。在两家机构中，耐甲氧西林金黄色葡萄球菌（MRSA）的患病率超过65%，远高于全国平均水平47.8%。数字整合使所有机构的培养检测增加了四倍，并改善了数据完整性和周转时间。空间分析和微生物实验室评估显示，诊断服务在地理上存在显著差异，偏远地区的机构进行基本检测会延迟超过四个小时。我们的研究是印度首个在州一级随时间创建如此广泛且与机构相关的抗菌药物耐药性情况的研究。政策影响包括需要一个州级抗菌药物耐药性监测仪表板，使采购与机构特定的耐药模式保持一致，以及进行常规管理审计。在临床上，本研究证明了本地化抗菌谱在资源有限环境中指导经验性治疗的实用性。本研究为将抗菌药物耐药性监测嵌入低收入和中等收入国家常规卫生系统工作流程提供了一个可扩展的框架。
