Recasting Antimicrobial Resistance Surveillance Through Contemporary Analytical Frameworks: An Integrated Analysis Using the WHO Bacterial Priority Pathogens List 2024 and AWaRe Classification in a Tertiary Care Hospital of Saurashtra, Western India.

BACKGROUND

Indian antimicrobial resistance (AMR) surveillance rarely uses contemporary global frameworks, and Saurashtra is under-represented in the national evidence base. We applied the WHO Bacterial Priority Pathogens List (BPPL) 2024 and the WHO AWaRe (Access-Watch-Reserve) classification to institutional surveillance data, with national and global benchmarking.

METHODS

Cross-sectional analysis of 2,195 non-duplicate clinical bacterial isolates (May-October 2024) at a 1,200-bed government tertiary care teaching hospital. Susceptibility testing followed CLSI M100-S33 (VITEK 2 Compact; Kirby-Bauer disk diffusion); multi-drug resistance (MDR) followed Magiorakos criteria. Isolates were assigned to BPPL 2024 tiers by resistant phenotype, and agent-level resistance was grouped by AWaRe 2023 category. MDR correlates were explored by multivariable logistic regression. The isolate was the unit of analysis; proportions describe cultured isolates, not infections or patients.

RESULTS

Isolates meeting Critical-priority phenotypes numbered 1,192 (54.3% of the isolate pool): third-generation cephalosporin-resistant Enterobacterales (n = 1,086; 49.5%; ceftriaxone resistance 78% in E. coli and 61% in K. pneumoniae) and carbapenem-resistant Acinetobacter baumannii (n = 106; 4.8%). High-priority phenotypes accounted for at most 228 isolates (10.4%). Within the Access group, Enterobacterales resistance was high to ampicillin (89.7% in E. coli) and amoxicillin/clavulanic acid (77-83%) but lower to gentamicin (22-33%); Watch-group fluoroquinolone resistance was 47-73%. Meropenem resistance in E. coli (1%) and K. pneumoniae (7%) was markedly lower than ICMR AMRSN 2023 national estimates (40% and 54%). MDR was present in 58.6% of isolates and was independently associated with ICU admission, age >60 years, tracheal-aspirate specimens, and surgical-department admission.

CONCLUSIONS

Reading isolate-level surveillance data through the BPPL 2024 and AWaRe frameworks adds a priority- and stewardship-oriented layer to the conventional antibiogram. These proportions describe cultured isolates, not the frequency of resistant infection in patients. The low Enterobacterales carbapenem resistance relative to national benchmarks warrants multi-center, consumption-linked confirmation.