Antimicrobial resistance tightens grip on Keralam, say latest report
The data for 2025 released by the Kerala Antimicrobial Resistance Surveillance Network show that 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. Drug-resistant bacteria seem to be the norm now, not the exception in Keralam’s hospitals
Antimicrobial resistance (AMR) in Keralam has become a significant concern, as indicated by a recent report from the Kerala Antimicrobial Resistance Surveillance Network (KARS-Net). The report, which covers data from January 1 to December 31, 2025, reveals that AMR is now a common issue in the state's hospitals, affecting not just intensive care units but also community-acquired infections.
KARS-Net, coordinated by the Department of Microbiology at Government Medical College in Thiruvananthapuram, has been tracking AMR since 2019 and currently includes 59 government and private institutions.
The report analyzed antimicrobial susceptibility data on 65,849 unique-patient isolates of nine priority pathogens. E. coli was the most frequently isolated bacterium, accounting for 41.2% of all isolates, followed by Klebsiella species (25.8%), Pseudomonas species (10.8%), Staphylococcus aureus (8.9%), and Enterococcus species (8.6%). Notably, 46% of these isolates were from in-patients, 45% from outpatients, and 9% from ICU settings.
Among the most concerning findings are the high levels of resistance to common antibiotics among Gram-negative pathogens. For E. coli, 73% of blood isolates produced extended-spectrum beta-lactamase enzymes, rendering them ineffective against common penicillin and cephalosporin antibiotics. Furthermore, 8% of Klebsiella species isolates were resistant to Carbapenems, the last-resort class of antibiotics.
Ciprofloxacin resistance was found at 62% among E. coli, and Acinetobacter species showed 52% Carbapenem resistance in blood isolates. Pseudomonas species demonstrated 20% Meropenem resistance.
In Gram-positive pathogens, the report reveals an alarming increase in methicillin-resistant Staphylococcus aureus (MRSA), with 33% of blood isolates showing resistance. Enterococcus isolates also exhibited resistance to vancomycin (4%) and linezolid (1%).
The report highlights the emergence of Colistin resistance, an older and more toxic antibiotic typically reserved for treating severe infections caused by highly-resistant Gram-negative bacteria. In Keralam, Colistin resistance stands at a concerning 0.1%, with emerging resistance indicating a potential threat to treating severe infections.
Despite the high levels of AMR, the report suggests that the state's AMR containment strategy has been effective, leading to the establishment of an AMR surveillance system. However, the prevalence of AMR persists, suggesting that changes in prescribing behavior and antibiotic abuse remain unaddressed. The report calls for targeted stewardship interventions to change prescribing behavior and community-level awareness and antibiotic literacy initiatives to combat the growing AMR crisis in Keralam.
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