India multidrug-resistant superbugs: India may be facing a far bigger “silent” superbug challenge than many realise, according to a new international study on multidrug-resistant organisms (MDROs).
An analysis of swab samples taken from patients before routine endoscopy procedures has suggested that about 83 per cent of patients in India could be carrying at least one multidrug-resistant organism. The study, published in the journal eClinicalMedicine, examined rectal and throat–nose swabs collected between January 2022 and October 2024 from 1,244 patients treated at tertiary care centres in the Netherlands, India, Italy and the United States.
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Overall, 37 per cent of all patients (462 out of 1,244) were found to be colonised with an MDRO. However, the country-wise data revealed striking differences. In India, 290 out of 349 patients, roughly 83.1 per cent, carried a multidrug-resistant organism. In comparison, prevalence was 10.8 per cent in the Netherlands (37 of 343 patients), 31.5 per cent in Italy (66 of 209), and 20.1 per cent in the US (69 of 343).
Based on these findings, the researchers estimate that a patient in India may be about 100 times more likely to harbour an MDRO than a patient in the Netherlands, while a patient in Italy may be about 6.6 times more likely. The study involved authors from multiple centres, including AIG Hospitals in Hyderabad.
The most common multidrug-resistant organisms also varied by country. In India, extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), a group of bacteria resistant to many commonly used antibiotics, were the most frequently detected. In the United States arm of the study, MRSA (methicillin-resistant Staphylococcus aureus) was identified more often.
The analysis also pointed to additional risk factors. Patients with chronic lung disease or congestive heart failure, and those with a history of taking penicillin-class antibiotics, were more likely to carry multidrug-resistant organisms.
The authors say these results highlight how background colonisation with MDROs can differ sharply between regions and reflect underlying patterns of antimicrobial resistance. They argue that strategies to prevent endoscope-related transmission of such organisms should not follow a universal template, but instead be tailored to local resistance profiles.
They recommend that pre-procedure screening and targeted infection-prevention measures be integrated into broader, region-specific infection control policies, especially in high-burden settings such as India, where silent carriage of MDROs appears to be extremely common.