India's Antimicrobial Resistance Surveillance & Research Initiative

AMRSN Network

Antimicrobial resistance (AMR) is a major public health concern for India where the burden of infectious diseases is high and consumption of antibiotics is huge and un-regulated. Reliable estimates of AMR burden are fundamental for addressing its impacts and information on local resistance patterns is crucial for devising empirical as well as pathogen specific therapy for diverse epidemiological settings.

The main goals of ICMR AMRSN are to:
  • Establish network of hospitals to monitor trends in the antimicrobial susceptibility profile of clinically important bacteria and fungi limited to human health
  • Include comprehensive molecular studies for identifying the clonality of drug-resistant pathogens and their transmission dynamics to enable better understanding of AMR in the Indian context and develop suitable interventions
  • Disseminate information on AMR in pathogenic organisms to stakeholders to promote interventions that reduce AMR
  • Create data management system for data collection and analysis

In view of this, to generate relevant evidence on the extent of drug resistance and a nationally representative reliable data on AMR which was not existent from India, ICMR initiated Antimicrobial Resistance Surveillance and Research Network (AMRSN) in 2013.

The ICMR’s network focuses on following six pathogenic groups:

  • Enterobacteriaceae causing sepsis,
  • Gram negative non-fermenters,
  • Enteric fever pathogens,
  • Diarrheagenic bacterial organisms,
  • Gram positives: staphylococci and enterococci and
  • Fungal pathogens (excluded in WHO priority pathogens)-yeasts (Candida and Cryptococcus spp.) and mycelial fungi (Aspergillus spp. and Zygomycetes spp.).

The pathogenic groups identified by advisory group also align well with the WHO priority pathogen list released in 2017.

Network Composition

AMRSN includes six Nodal Centers (NCs) for each pathogenic group that are located in four tertiary care medical institutions for the above mentioned pathogenic groups.

• Diarrheagenic bacterial organisms, CMC, Vellore
• Enteric fever pathogens: AIIMS, New Delhi
• Enterobacteriaceae causing sepsis: PGIMER, Chandigarh
• Gram negative non fermenters: CMC, Vellore
• Gram positives including MRSA: JIPMER, Pondicherry
• Fungal infections: PGIMER, Chandigarh

The surveillance network is managed by coordinating centre at ICMR Headquarters at New Delhi along with the nodal centers.

There are 16 regional centers (RC) in the network. Sixteen regional labs from tertiary care hospitals to provide data across the country are in network as Regional Centers (RCs) which are providing data on fixed number of isolates for each pathogenic group.

The NCs and RCs follow standard operating procedures (SOPs) of Bacteriology and Mycology formulated by ICMR to collect resistance data. The NCs focus on the identified resistant organisms and also exchange organisms amongst each other according to their expertise for in-depth molecular studies of the group of pathogens for which they are responsible.

ICMR has developed a real time online AMR data entry system for its network and will have AMR data analysis capacity. It is a user-friendly web-based informatics solution/suite for collection, storage and analysis of surveillance data. The bacterial and fungal data entered by RCs are validated by NCs initially. The analysis of the data from the surveillance network provides valuable and essential information required for targeted antibiotic policy and implementation of antibiotic stewardship in a tertiary care medical facility.


Centers

  • All India Institute of Medical Sciences (AIIMS), New Delhi
    Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
    Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puduchery
    Christian Medical College (CMC), Vellore
  • Mahatma Gandhi Institute of Medical Sciences (MGIMS), Wardha, Sevagram
    Tata Medical Center (TMC), Kolkata
    Sir Ganga Ram Hospital (SGRH), New Delhi
    Apollo Hospitals, Chennai
    P.D. Hinduja National Hospital, Mumbai
    Armed Forces Medical College (AFMC), Pune
    King George’s Medical University (KGMU), Lucknow
    All India Institute of Medical Sciences (AIIMS), Bhopal
    Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC & GH), Mumbai
    Assam Medical College & Hospital (AMCH), Assam
    Assam Medical College & Hospital (AMCH), Assam
    Nizam's Institute of Medical Sciences (NIMS), Hyderabad
    Kasturba Medical college, Manipal, Karnataka (KMC)
    Institute of Postgraduate Medical Education & Research (IPGME & R), Kolkata
    Sher-e-Kashmir Institute of Medical Sciences (SKIMS), Srinagar
    All India Institute of Medical Sciences (AIIMS), Jodhpur

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