As antibiotics increasingly fail, researchers at AIIMS Delhi are leading the battle against superbugs through early diagnosis, biomarker research, and rational antibiotic use. A recent case of a 50-year-old man with resistant bacterial meningitis underscores the urgency. The institute is running multiple projects to slow down antimicrobial resistance.
A 50-year-old man arrived at the All India Institute of Medical Sciences (AIIMS) in Delhi with fever, headache, neck stiffness, and confusion. Doctors suspected meningitis and tested whether it was viral or bacterial. Lab results confirmed a bacterial infection, but the bacteria was resistant to penicillin. "What surprised us was that this patient had never been hospitalised before," says Dr Bimal Kumar Das, professor and head of microbiology at AIIMS Delhi.
Antimicrobial resistance (AMR), where micro-organisms evolve to survive medicines, poses a serious public health threat. It is projected to cause 10 million deaths worldwide by 2050. In India, an estimated 2.97 lakh deaths were linked to AMR in 2019, and the country remains one of the largest consumers of antibiotics.
Tackling AMR is a priority at AIIMS, which is running around 15 research projects focused on understanding resistance patterns, improving diagnosis, and promoting rational antibiotic use. The institute has been designated as an Infectious Disease Research Diagnostic Laboratory (IRDL) centre and serves as the nodal coordinating centre for the Antimicrobial Resistance Surveillance Network (AMRSN). "The focus is on early diagnosis, targeted therapy and strong hospital infection control," says Dr Das.
The growing resistance of Salmonella typhi, which causes typhoid, is a serious concern in north India, studied using advanced genetic testing. A major driver of AMR is empirical antibiotic use, started before identifying the pathogen, especially in critical patients. "We begin empirical therapy based on the most likely cause. But if we cannot identify the organism later, antibiotics continue longer than necessary," says Dr Hitender Gautam, professor of microbiology at AIIMS Delhi.
One key area is sepsis, a life-threatening response to infection that can lead to organ failure. Dr Gautam's team is identifying site-specific biomarkers for bacteremia, where bacteria enter the bloodstream. For bacterial meningitis, research targets viable but non-culturable (VBNC) bacteria to avoid unnecessary antibiotics. Novel DNA and RNA signatures are being developed to detect resistance in ESKAPE pathogens like Klebsiella pneumoniae.
Urinary tract infections (UTIs) are increasingly drug-resistant due to misuse, including treatment of asymptomatic bacteriuria. AIIMS is exploring CRISPR-Cas9-based gene-editing therapy to target resistant E. coli. India-specific data is being generated on new antibiotics such as Eravacycline and Omadacycline. Quorum sensing inhibitors, like furanone and gallium nitrate, disrupt bacterial communication to prevent biofilms.
For multidrug-resistant tuberculosis, the BPaL-M regimen—combining bedaquiline, pretomanid, linezolid, and moxifloxacin—shortens treatment to six months with over 90 per cent success rates. Genomic sequencing enables rapid resistance identification. "Only this multi-pronged approach of early diagnosis, targeted therapy, innovation and strict infection control can slow the rise of superbugs in India," experts stress.
