# Changing Battlelines: 12-Month Antimicrobial Resistance Trends at a Tertiary Care Hospital in Nagpur, Maharashtra, India

## TL;DR

This study tracks antimicrobial resistance trends over 12 months at a hospital in India, highlighting the need for better antibiotic use and local treatment guidelines.

## Contribution

The study provides a detailed 12-month surveillance of AMR patterns in a tertiary hospital in India, supporting local antibiotic stewardship.

## Key findings

- Gram-negative bacteria like E. coli and Klebsiella dominated clinical isolates with high resistance to common antibiotics.
- MRSA and VRE were identified among Gram-positive isolates, with high resistance to penicillin but low linezolid resistance.
- High resistance to third-generation cephalosporins and fluoroquinolones was observed in Gram-negative organisms.

## Abstract

Background: The global surge in antimicrobial resistance (AMR) presents a significant public health threat, especially in developing nations like India with high infectious disease burdens and unregulated antibiotic use. Surveillance of bacterial pathogens and their resistance profiles is essential to inform empirical treatment and formulate antibiotic stewardship policies. This study was conducted to evaluate the bacteriological profile and antimicrobial resistance patterns of clinical isolates over a 12-month period at a tertiary care hospital. The findings aim to guide empirical antibiotic therapy and strengthen hospital antibiotic stewardship policies through the development of a local antibiogram.

Methods: A retrospective, observational study was conducted in the Microbiology Laboratory of Indira Gandhi Government Medical College and Hospital in Nagpur, Maharashtra, India, from May 2024 to April 2025. Out of a total of 22,125 clinical specimens, 4603 (22.87%) were bacterial culture positive, and identification was done using standard conventional microbiological procedures. Antimicrobial susceptibility testing (AST) was performed in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines M100 and M45 for Salmonella typhi and Vibrio cholerae. Data was analyzed.

Results: Of the total samples, 4603 (22.87%) yielded positive cultures. Gram-negative organisms predominated (80.42%). Among these, Escherichia coli (35.7%), Klebsiella pneumoniae (28.4%), Pseudomonas aeruginosa (21.1%), and Acinetobacter spp. (13%) were the most common pathogens. Of the 901 (19.6%) Gram-positive isolates, 73.7% were Staphylococcus aureus, of which 66.1% were methicillin-resistant Staphylococcus aureus (MRSA). Enterococcus comprised 152 (16.9%) isolates, and out of these, 4.6% isolates were vancomycin-resistant Enterococcus (VRE). High resistance rates were observed among Gram-negative organisms to third-generation cephalosporins (>70%) and fluoroquinolones (>40%). Among Gram-positive bacteria, resistance to penicillin was nearly universal (>95%), while linezolid resistance remained low (8.1%).

Conclusion: The study reveals a high prevalence of multidrug-resistant organisms in clinical samples, emphasizing the urgent need for routine surveillance, infection control measures, and rational antibiotic usage. Data generated from such studies can guide empirical therapy and help to develop regional antibiograms.