Antimicrobial resistance, or AMR, is a term increasingly making headlines worldwide, particularly in India, where it is being described as a growing crisis in healthcare. It is a silent battle that grows louder each year, often leaving doctors helpless in its wake.
We spoke to Dr Devi Prasad Shetty, a cardiac surgeon and chairman of Narayana Health, to understand the implications of AMR. Reflecting on his early years as a heart surgeon, Dr Shetty shared, "In my first decade of performing heart surgeries, initially in Kolkata and later in Bangalore, when a patient became unstable post-surgery, sepsis was never the diagnosis. Antibiotics were typically stopped 24 to 48 hours after the procedure. Today, however, if a patient becomes unstable, sepsis is the first consideration before assessing myocardial function or other factors."
This shift is alarming. Sepsis, a life-threatening medical emergency, occurs when the body's response to an infection or injury spirals out of control. It can escalate to septic shock, characterised by a dramatic drop in blood pressure, which damages vital organs like the lungs, kidneys and liver. Once a secondary concern after surgery, sepsis is now often the primary focus.
According to doctors, nearly 45 per cent of sepsis cases in intensive care units are caused by drug-resistant bacteria, particularly multi-drug-resistant strains. Dr Shetty remarked, "As doctors, we can achieve incredible feats, but when a patient contracts an infection from resistant bacteria, we are utterly helpless. Hours of painstaking effort to reconstruct the heart or other vital organs can be rendered futile by these resistant infections."
This issue is not confined to heart surgery. Recent data reveals a grim reality for India, the world's largest consumer of antibiotics, exacerbating a crisis that extends beyond hospitals. One significant driver of AMR is the food we eat. Despite growing concerns, the use of antibiotics in livestock feed remains largely unregulated, leading to a loss of efficacy in the antibiotics essential for human medicine.
Dr Shetty emphasised, "Years ago, we suggested that the government restrict antibiotic use in veterinary practices, particularly in animal feed. In 2006, the European Union banned antibiotics in livestock feed entirely. Even in the US, such use is significantly restricted. Yet, in India, we have made little progress in reducing or halting this practice. As a result, much of the meat we consume is saturated with antibiotics, rendering many of these drugs ineffective."
While industries are striving to develop new antibiotics, there is no guarantee of an imminent breakthrough. Experts predict it could take five to ten years before effective treatments for resistant infections are available. Dr Shetty expressed his concerns: "The industry is working hard, but it will likely be years before we see results. In the meantime, we must focus on controlling the misuse of antibiotics in treating patients and in livestock practices. If we don’t act now, more existing antibiotics will lose their effectiveness, making even minor surgeries a significant challenge."
Without immediate intervention, the spectre of a pre-penicillin era looms—where infections, not surgeries, claim most lives.