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Colistin resistance: AIIMS sounds the alarm

The All India Institute of Medical Sciences in Delhi.

In yet another concerning insight into India’s growing drug resistance epidemic, the All India Institute of Medical Sciences (AIIMS) in Delhi has sounded alarms over colistin resistance among patients.

The Trauma Centre at the facility has reported that, of 846 people studied who were infected with the Klebsiella pneumoniae bacterium, 22 did not respond to colistin, which is used as a last-resort therapy in the treatment of multiple multi-drug resistant bacteria. Of the 22 colistin-resistant patients, ten died within a fortnight of admission. The research was conducted in a joint venture between AIIMS, the Christian Medical College in Vellore, and the US Center for Disease Control and Prevention. 

“Stray cases of colistin resistance have been reported from ICU settings in the past, but the numbers shown here are significant and raise concern about the rising incidence of multi-drug resistance in India,” critical care expert Dr Sumit Ray said of the results. The researchers in question added that “action is needed from a broad range of stakeholders, including clinicians, microbiologists and public health officials, to limit the spread of this critically-important multi-drug resistant organism”, noting that resistance to other last-line therapies was observed in the 22 colistin-resistant patient. 68 percent of the 22 were found to be extensively drug-resistant, whilst all were multidrug resistant. 

Colistin resistance has been highlighted as an issue in India before, notably prompting a ban on the antibiotic’s use in the food production sector in India earlier this year. In particular, The poultry sector has regularly been implicated in rising rates of drug-resistant infections, attributed to misuse of antibiotics. 

The World Health Organization (WHO) names antimicrobial resistance as one of the ten biggest threats to public health globally and the reasons why are patent, as the cases of colistin resistance at AIIMS shows. If even lastline therapies become obsolete in treatments, a plethora of conditions may become all but impossible to treat – carrying dire implications for the patients themselves and for public health more broadly. 

India is acknowledging the importance of fighting antimicrobial resistance. Union Health Minister Dr Harsh Vardhan has pledged to act against antimicrobial resistance and India is a member of an international coalition of nations focused on tackling antimicrobial resistance – both welcome steps in the fight against what is a public health challenge of an ever-growing magnitude.

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