National Programme on Containment of Anti-Microbial Resistance (AMR)

Antimicrobial resistance is a growing public health concern worldwide. Resistance has emerged even to newer & more potent antimicrobial agents like Carbapenems. The rapid spread of multi-drug resistant bacteria and the lack of new antibiotics to treat infections caused by these organisms pose a rapidly increasing threat to human health which urgently needs to be tackled if we are to contain the problem and prevent untreatable illness from becoming a reality.

India has given due cognizance to the problem of Antimicrobial resistance (AMR) and to tackle this issue Government of India launched a “National Programme on Containment of Antimicrobial Resistance” during the 12^th five year plan (2012-2017). A network of 10 State medical colleges was included under the programme as of March 2017. The network of labs is being expanded in a phased manner and currently includes 20 state medical college labs.

The main objectives of this programme are: 

• Establish a laboratory based AMR surveillance system in the country to generate quality data on antimicrobial resistance
• Carry out surveillance of antimicrobial usage in different health care settings
• Strengthen infection control practices and promote rational use of antimicrobials through Antimicrobial stewardship activities
• Generate awareness amongst health care providers and community on antimicrobial resistance and rational use of antimicrobials.

Current status of AMR programme (as of October 2018)

AMR Surveillance:

NCDC is the focal point for implementation of the programme. Currently the network of labs includes 20 state medical colleges from 18 states. These labs are required to submit AMR surveillance data of seven priority bacterial pathogens of public health importance to determine the magnitude and trends of AMR in different geographical regions of the country:  Klebsiella spp., Escherichia coli, Staphylococcus aureus, and Enterococcus species, Pseudomonas spp, Acinetobacter spp., Salmonella enterica serotypes Typhi and Paratyphi. The list of 20 labs currently included in the network is as below:

• BJMC Pune, Maharashtra
• BJMC Ahmedabad, Gujarat
• GSVM Medical college Kanpur, UP
• GMCH Chandigarh
• SMS Medical College Jaipur, Rajasthan
• LHMC, Delhi
• VMMC and Safdarjung Hospital, Delhi
• MMC & RI Mysore, Karnataka
• KAPV Government Medical College, Trichy, Tamil Nadu
• Government Medical College, Thiruvanathapuram, Kerala
• Guwahati Medical college, Guwahati, Assam
• Mahatma Gandhi Memorial Medical college, Indore, MP
• NEIGRIHMs, Shillong, Meghalaya
• IGMC, Shimla, HP
• Medical College, Jammu
• Medical College, Aurangabad, Maharashtra
• Osmania General Hospital & Osmania Medical College, Hyderabad, Telangana
• SCB Medical College Hospital, Cuttack, Odisha
• Agartala Govt. Medical College & GBP Hospital
• Guntur Medical College & Govt. General Hospital, Andhra Pradesh

Under the programme AMR surveillance data is to be submitted in the WHONET format on a quarterly basis and feedback is provided to the labs by NCDC regarding completeness of data etc. The data is analysed at NCDC on an annual basis. In 2019-20, this network is to be expanded to another 5 state medical colleges, representing states which are not yet included under the network.

For the year 2017, AMR surveillance data was submitted by 10 network labs (first 10 in the list above). The data has been analysed and analysed data has been uploaded on NCDC website. As per trends obtained from the 10 network laboratories for the year 2017, resistance rates to most of the antimicrobials are high in these common pathogens including fluoroquinolones, third generation cephalosporins and carbapenems. However, no resistance has been reported for reserve drugs such as for vancomycin in S. aureus and for colistin in Gram negative bacteria.

National Treatment Guidelines:

A common unified National Treatment Guidelines for antimicrobial use in infectious diseases has been released and uploaded on the website. It can serve as a guide to all the hospitals to formulate their own guidelines on basis of which physicians will be trained.

Infection Prevention & Control guidelines and surveillance of Healthcare associated infections :

• An interim concise guideline on infection control has been uploaded on NCDC website as a ready reference for the hospitals to start implementing infection control practices in their settings.
• National Infection control guidelines have been drafted with support from WHO India and is in the process of finalization.
• NCDC sites in a phased manner are joining the ICMR-AIIMS HAI surveillance network. For more details on ICMR-AIIMS HAI surveillance network may refer to https://www.haisindia.com/

IEC Activities:

Various IEC activities are conducted round the year including quiz competition in schools, public lectures in academic Institutions and radio programmes, participation in Health fairs etc.  

Review meetings, trainings and workshops

The network labs are provided training on WHONET software and onsite support through site visits. All the labs have been trained for Micro broth dilution testing for colistin and vancomycin. Annual meetings are conducted to review the working of the network labs under the programme.

Strengthening Laboratory capacity for AMR detection

During onsite visits, the lab capacity is assessed and hand holding is done for strengthening Internal Quality Control and Proficiency testing in these labs. 1% resistant strains are to be submitted every quarter by the sites for confirmation to NCDC. Most labs under the programme are enrolled onto the IAMM EQAS programme.