Carbapenem Resistance in India: A Systematic Review of Epidemiology, Diagnostic Strategies, and Therapeutic Approaches.

BACKGROUND

Carbapenem-resistant gram-negative infections pose a major public health challenge in India due to high antibiotic consumption, limited diagnostic access, and regional variation in resistance mechanisms. We systematically reviewed recent data to evaluate prevalence, diagnostics, and therapeutic strategies.

METHODS

Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Embase, and Google Scholar for studies (January 2019-December 2024) reporting carbapenem resistance in clinical gram-negative isolates from India. Data on prevalence, molecular mechanisms, diagnostics, and treatment outcomes were extracted. Study quality was assessed using the Joanna Briggs Institute (JBI) Checklist.

RESULTS

From 75 studies (> 25,000 isolates), pooled resistance rates were K. pneumoniae 42.3%, E. coli 35.6%, A. baumannii 58.9%, and P. aeruginosa 41.7%. NDM (65%) and OXA-48-like (20%) enzymes predominated. Only 38% of studies employed rapid molecular diagnostics. Treatment strategies included ceftazidime-avibactam ± aztreonam, colistin-based regimens, and cefiderocol, but outcomes were inconsistent.

CONCLUSIONS

Carbapenem resistance in India remains alarmingly high, primarily driven by NDM and OXA-type carbapenemases. Optimised diagnostics, improved access to effective antimicrobials, robust antimicrobial stewardship, and national surveillance are critical to mitigate its growing clinical and public health impact.