Experts call for urgent measures to address complicated UTIs and AMR in India

At the 13th Annual International Best of Brussels Symposium on Intensive Care & Emergency Medicine held in Pune, leading medical experts discussed the growing challenge of complicated urinary tract infections (UTIs) and antimicrobial resistance (AMR) in India. The press conference featured Dr Kapil Zirpe, Dr Shirish Prayag, Dr Subhal Dixit, Dr Deepak Govil, and Dr V Balaji, who collectively called for integrated, region-specific strategies to manage the issue.

Dr Shirish Prayag, Organising Chairperson of the symposium, stated that complicated UTIs are among the most common bacterial infections in India. “Bacterial AMR is estimated to have caused or contributed to 49.5 lakh deaths worldwide and is directly responsible for 12.7 lakh deaths, according to the World Health Organization (WHO) data,” said Dr Prayag. He cited Escherichia coli and Klebsiella pneumoniae as the primary bacterial causes of complicated UTIs.

“Patients with complicated urinary tract infections require surgeries, renal replacement, utmost intensive care in ICU and sometimes ventilation. With the rising prevalence of AMR, treating complicated UTI is becoming extremely challenging, thus requiring longer hospital stays,” he said. Dr Prayag also underscored the need for timely and targeted antibiotic use, “We need to find new antibiotics. The biggest cause of AMR is the misuse of antibiotics… That specific antibiotic should be used.”

He further noted a critical gap in the country’s medical curriculum. “The MBBS course should be upgraded regularly to include current AMR knowledge… The government must strictly monitor antibiotic sales.”

Dr Kapil Zirpe, Organising Secretary, pointed to growing resistance to carbapenem. “When E. coli and other pathogens become resistant to anti-infectives like carbapenem, it is termed as carbapenem-resistant Enterobacterales (CRE). In India, mortality associated with CRE infections is as high as 20 per cent to 54.3 per cent, thus underscoring the need for newer treatment options.”

Adding to this, Dr Subhal Dixit, Joint Organising Secretary of the symposium, said, “Increasing resistance complicates treatment, making outcomes uncertain, even in simple cystitis. Antibiotics should be started only after proper collection of culture… strictly based on a culture sensitivity–guided protocol.” He called for more structured training programmes in both community and hospital settings.

Dr Deepak Govil, Director of Critical Care Medicine at Medanta Institute of Critical Care and Anaesthesiology, emphasised the need for future research. “Future research should also be conducted to enable targeted antimicrobial therapy, to both tackle the rise of AMR as well as the tackle the rising prevalence of complicated UTI. A multifaceted approach is imperative… involving increased awareness, novel treatment options, improving hygiene, and addressing the antibiotic resistance issue holistically.”

Dr V Balaji, Professor of Clinical Microbiology at CMC Vellore and a key member of the INSAR network supported by WHO-SEARO and ICMR, discussed recent developments. “We have observed significant link between of Antimicrobial Resistance (AMR) on the treatment of Complicated UTI. Till now, no new drug has ever been discovered in India, whether it’s for cancer, hypertension, diabetes, or even antibiotics. But for the first time, a medical chemist from Chennai has discovered a new antibiotic called Cefepime Enmetazobactam. This is a big achievement because usually, when a drug is discovered abroad, it takes 5–6 years to reach India. First, their own demand is fulfilled, and then it’s exported to us. And even when it comes to India, it’s 3–5 times more expensive. But this time, since the drug is made in India, it has been released here first, and it’s available at one-tenth of the cost. It’s highly effective and affordable, especially for treating complicated urinary tract infections. This is truly a remarkable and positive step that happened in the past year, and it’s something we should all be proud of.”