Mapping the AMR Infection Landscape in Bihar: Implications for Strengthening Policy and Clinical Practice

Area of Science:

• Public Health
• Infectious Diseases
• Clinical Microbiology

Background:

• Antimicrobial resistance (AMR) is a critical global health concern, particularly impacting low- and middle-income countries (LMICs) with limited surveillance.
• Bihar, a populous and under-resourced Indian state, lacks comprehensive national AMR monitoring.
• Underdeveloped surveillance infrastructure in LMICs hinders effective AMR containment strategies.

Purpose of the Study:

• To characterize the AMR infection landscape in five tertiary care hospitals in Bihar over three years (2022-2024).
• To evaluate the feasibility of integrating digital workflows for real-time microbiological reporting and AMR surveillance.
• To assess the impact of digital integration on laboratory testing and data quality.

Main Methods:

• Standardized antimicrobial susceptibility testing (AST) on over 48,000 clinical samples (urine, pus, blood) following CLSI guidelines.
• Digitization of facility-level data into an open-source AMR reporting system for automated antibiogram generation.
• Spatial analysis and microbiology laboratory assessments to identify diagnostic access disparities.

Main Results:

• High levels of resistance observed across key pathogens to common antibiotics like beta-lactams, carbapenems, and fluoroquinolones.
• Significant variations in antimicrobial sensitivity, e.g., *E. coli* nitrofurantoin sensitivity ranged from 44.7% to 86.5%.
• Methicillin-resistant *Staphylococcus aureus* (MRSA) prevalence exceeded 65% in two hospitals, significantly higher than the national average. Digital integration increased culture testing four-fold and improved data completeness.

Conclusions:

• This study provides the first comprehensive, state-level AMR surveillance data from India over time.
• Policy recommendations include establishing a state-level AMR surveillance dashboard and aligning drug procurement with local resistance patterns.
• Localized antibiograms are crucial for guiding empirical therapy in resource-limited settings, with the study offering a scalable framework for LMICs.