Lok Sabha Question No. 1555 (UNSTARRED), answered on 2023-02-10
Subject: Antimicrobial Resistance
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sangeeta Azad

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 1555 TO BE ANSWERED ON 10.02.2023

## ANTIMICROBIAL RESISTANCE

## 1555.  SHRIMATI SANGEETA AZAD:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether  the  Government  takes  cognizance  of  the  increasing  issue  of  Antimicrobial Resistance (AMR) which can be one of the public health crises in coming years and if so, the details thereof;
- (b) the initiatives planned to prevent the increasing risk of AMR;
- (c) whether  the  Government  is  planning  to  expand  and  diversify  the  AMR  National Action Plans (NAPs) and if so, the details thereof;
- (d) whether  robust  surveillance  systems  are  being  followed  in  the  hospitals  to  facilitate early detection of AMR; and
- (e) if so, details thereof and if not, the reasons therefor?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) to (e):

Government is aware about the challenges posed by anti-microbial resistance (AMR) in India. It is a multifaceted problem with significant consequences for individuals as well as Health Care Systems. To capture the trends and pattern of AMR in India, ICMR has established an AMR surveillance and research network (AMRSN) to monitor data on the trends and patterns of antimicrobial resistance of clinically important bacteria and fungi limited to human health from 30 tertiary hospitals.

MoH&FW has taken several steps to address the issue of AMR. Some of the steps are:

- i. AMR surveillance  network  has  been  strengthened  by  establishing  labs  in  State Medical Colleges. 38 sites in 30 States/UTs have been included in this network so far.
- ii. National  action  plan  on  containment  of  Antimicrobial  Resistance  (NAPAMR) focusing on One Health approach was launched in April 2017 with the aim of  involving  various  stakeholder  ministries/departments.  Delhi  Declaration  on AMR-  an  inter-ministerial consensus  was  signed  by  the  ministers of the concerned ministries pledging their support in AMR containment.
- iii. AMR  Surveillance  Network: ICMR  has  established  AMR  surveillance  and research  network  (AMRSN)  comprising  30  tertiary  care  hospitals,  both  private and  government  to  generate  evidence  and  capture  trends  and  patterns  of  drug resistant infections in the country.
- iv. AMR Research & International Collaboration: ICMR has taken initiatives to develop  new  drugs  /medicines  through  international  collaborations  in  order  to strengthen medical research in AMR.

Further,  to  create  awareness  IEC  materials  including  audios,  videos,  social  media messages  and  Outdoor  Media  has  developed  and  is  also  shared  with  states  for  further dissemination.  MoHFW has  released  National  Guidelines  for  Infection  Prevention  and Control in Healthcare Facilities in Jan 2020. https://ncdc.gov.in/showfile.php?lid=431 National  Center  for  Disease  Control  under  MoHFW  is  conducting  several  stakeholder consultations to monitor the implementation of existing National action plan on AMR by various department and ministries. The consultations are also to guide the development of a more practical and implementable National action plan on AMR 2.0.

Under the National Programme on AMR Containment, 38 state medical colleges/large Government hospitals in 30 states/UTs have been strengthened to do AMR surveillance on  7  priority  pathogens (placed  at  Annexure  I  &  II  respectively). These  sites  have robust surveillance systems to facilitate early detection on AMR. AMR emerging alerts are also confirmed at the National Reference Laboratory.

## Annexure I

|   S. No. | Name of the site Included under AMRsurveillance network   |
|----------|-----------------------------------------------------------|
|        1 | LHMC, Delhi                                               |
|        2 | VMMCand Safdarjung, Delhi                                 |
|        3 | MMCRI, Mysuru                                             |
|        4 | GMCH, Chandigarh                                          |
|        5 | BJMC, Ahmedabad                                           |
|        6 | BJMC, Pune                                                |
|        7 | SMS Medical College, Jaipur                               |
|        8 | GSVM Medical College, Kanpur                              |
|        9 | GMC, Assam                                                |
|       10 | KAPV GMC, Trichy                                          |
|       11 | NEIGRIHMS, Shillong                                       |
|       12 | GMC, Thiruvananthapuram                                   |
|       13 | MGMMC, Indore                                             |
|       14 | IGMC, Shimla                                              |
|       15 | GMC, Aurangabad                                           |
|       16 | OMC, Osmania                                              |
|       17 | GMCH, Jammu                                               |
|       18 | AGMC, Agartala                                            |
|       19 | GMC, Guntur                                               |
|       20 | SCB MC&H, Cuttack                                         |
|       21 | Pt. JNMMC Raipur, Chattisgarh                             |
|       22 | RIMS Ranchi                                               |
|       23 | PGIMS Rohtak, Haryana                                     |
|       24 | IGIMS Patna, Bihar                                        |
|       25 | Govt. Medical College, Haldwani, Uttarakhand              |
|       26 | Gandhi Medical College, Bhopal                            |
|       27 | STM, Calcutta                                             |
|       28 | LLRM, Meerut                                              |
|       29 | GMERS, Valsad                                             |
|       30 | Coimbatore Medical College and Hospital, Tamil Nadu       |
|       31 | KIMS Hubli, Karnataka                                     |
|       32 | Goa Medical College, Bambolim, Goa                        |
|       33 | IGMC &RI, Puducherry                                      |
|       34 | NAMOMERI, Silvassa, Dadar and Nagar Haveli                |
|       35 | MAMC, Delhi                                               |
|       36 | SPMC, Bikaner                                             |
|       37 | STNM Sikkim                                               |
|       38 | ZMC Mizoram                                               |

|   S. No. | Pathogens under AMR surveillance, by specimen type Organism   | Type of Clinical Specimen                                 |
|----------|---------------------------------------------------------------|-----------------------------------------------------------|
|        1 | Enterococcus species                                          |  Blood  Urine  Pus aspirate  Other sterile body fluid |
|        2 | Staphylococcus aureus                                         |  Blood  Pus aspirate  Other sterile body fluid         |
|        3 | Escherichia coli                                              |  Blood  Urine  Pus aspirate  Other sterile body fluid |
|        4 | Klebsiella species                                            |  Blood  Urine  Pus aspirate  Other sterile body fluid |
|        5 | Acinetobacter species                                         |  Blood  Urine  Pus aspirate  Other sterile body fluid |
|        6 | Pseudomonas species                                           |  Blood  Urine  Pus aspirate  Other sterile body fluid |
|        7 | Salmonella enterica serotypes Typhi and Paratyphi             |  Blood  Stool                                           |