What Happened
At Criticare 2026 — the 32nd Annual National Conference of the Indian Society of Critical Care Medicine (ISCCM) — leading intensivists and public health experts issued a strong call for intensified action on antimicrobial resistance (AMR) and hospital-acquired infections (HAIs) in India's intensive care units.
The conference, held in Chennai from February 25 to March 1, 2026, brought together critical care specialists from across India. The theme for Criticare 2026 is "Humanisation in the Era of Data Science," reflecting the intersection of patient-centred care and technology-driven medicine.
Experts highlighted that AMR is already responsible for nearly 7 lakh (700,000) deaths globally every year, with projections estimating 10 million annual deaths by 2050 — surpassing cancer as the leading cause of death globally. ICUs, where patients are most critically ill and most heavily treated with antibiotics, are considered the epicentre of AMR development and spread.
Speakers emphasised the urgent need for: (1) strict infection prevention and control (IPC) protocols in hospitals; (2) national-scale antimicrobial stewardship programmes (ASPs) to rationalize antibiotic use; and (3) restricting over-the-counter antibiotic dispensing, which fuels resistance development at the community level.
Static Topic Bridges
1. Antimicrobial Resistance (AMR) — What It Is and Why It Matters
Antimicrobial resistance occurs when bacteria, viruses, fungi, or parasites evolve to resist the drugs designed to kill them. In clinical practice, this means standard antibiotics stop working, making infections harder or impossible to treat — leading to longer hospital stays, higher costs, and higher mortality.
AMR as a "silent pandemic": - Global deaths attributed to AMR: ~700,000 per year currently - Projected deaths by 2050 (O'Neill Report, 2016): 10 million/year — exceeding cancer - Economic cost projection by 2050: USD 100 trillion in lost global GDP - ICUs are disproportionately affected because: (a) patients are immunocompromised, (b) invasive procedures (catheters, ventilators) create infection entry points, (c) broad-spectrum antibiotics are heavily used
Key resistant pathogens (ESKAPE organisms): Enterococcus faecium, Staphylococcus aureus (MRSA), Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species — these cause the majority of life-threatening hospital-acquired infections.
India-specific burden: India is considered one of the highest AMR-burden countries globally. Factors driving this include unrestricted antibiotic sales without prescription, high disease burden requiring antibiotics, poor sanitation and water quality (enabling spread of resistant strains), and widespread antibiotic use in agriculture and animal husbandry.
2. India's National Action Plan on AMR (NAP-AMR) and Policy Response
India launched its National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017–2021 in April 2017, aligned with the WHO Global Action Plan (GAP-AMR) adopted in 2015. NAP-AMR follows a "One Health" approach — recognising that human health, animal health, and environmental health are interconnected.
Six strategic pillars of NAP-AMR: 1. Improve awareness and understanding of AMR 2. Strengthen surveillance and research 3. Reduce infection incidence through effective sanitation, hygiene, and IPC 4. Optimize use of antimicrobials in human health, animals, and agriculture 5. Promote investments and increase resources for AMR activities 6. Strengthen India's international leadership on AMR (India-specific addition to WHO's five-pillar framework)
Key institutional players: - Ministry of Health and Family Welfare (MoHFW) — nodal ministry - ICMR — maintains the AMR Surveillance Network (data from 20+ state medical college labs) - National Centre for Disease Control (NCDC) — published National Treatment Guidelines for Antimicrobial Use - Food Safety and Standards Authority of India (FSSAI) — AMR in food supply chain
Schedule H1 Regulation: Since 2013, antibiotics under Schedule H1 of the Drugs and Cosmetics Act require a valid prescription and the pharmacist must record purchase details. However, enforcement remains weak in practice.
3. Antimicrobial Stewardship Programmes (ASPs) in Hospitals
An Antimicrobial Stewardship Programme (ASP) is a coordinated set of interventions to improve and measure the appropriate use of antibiotics in hospitals. The objective is to prescribe the right antibiotic, at the right dose, for the right duration, and for the right indication.
Key components of a hospital ASP: - Pre-authorization for broad-spectrum antibiotics (requiring infectious disease specialist approval) - Prospective audit and feedback (reviewing ongoing antibiotic prescriptions) - De-escalation protocols (switching from broad-spectrum to targeted antibiotics once culture results are available) - Antibiotic time-out (reassessing antibiotic necessity at 48–72 hours) - Regular antibiogram reports (local resistance pattern data shared with prescribers)
ICMR and hospital ASPs: ICMR launched the "Antibiotic Stewardship Programme" (AMSP) initiative in 2012, providing toolkits and support to hospitals. The National Programme on AMR Containment mandates that tertiary care government hospitals establish ASP committees.
ISCCM's role: The Indian Society of Critical Care Medicine has published the Indian Antimicrobial Prescription Guidelines for Critically Ill Patients, which are regularly updated to reflect local resistance patterns.
4. Infection Prevention and Control (IPC) in Healthcare Settings
Hospital-acquired infections (HAIs) — also called nosocomial infections — affect approximately 10–30% of ICU patients in low- and middle-income countries, compared to 3–5% in high-income countries. Reducing HAIs directly reduces antibiotic use and thereby slows AMR emergence.
Standard IPC measures: - Hand hygiene (5 Moments of Hand Hygiene — WHO protocol) - Environmental decontamination of ICU surfaces - Catheter-associated urinary tract infection (CAUTI) bundles - Ventilator-associated pneumonia (VAP) bundles - Central line-associated bloodstream infection (CLABSI) prevention protocols
India-specific challenge: The 2019 ICMR multicenter study found that in Indian ICUs, carbapenem-resistant organisms (CROs) — among the most difficult to treat — were isolated in over 60% of gram-negative bacterial infections, far above global averages.
Key Facts & Data
- AMR deaths globally (current): ~700,000 per year (nearly 7 lakh)
- AMR deaths projected by 2050: 10 million per year (O'Neill Commission, 2016)
- India's AMR burden: Among highest globally; carbapenem-resistant organisms in 60%+ ICU gram-negative infections
- NAP-AMR launch: April 2017; aligned with WHO Global Action Plan (2015)
- ISCCM: Indian Society of Critical Care Medicine — professional body for intensivists
- Criticare 2026: 32nd annual conference, Chennai, Feb 25 – Mar 1, 2026; theme: "Humanisation in the Era of Data Science"
- Schedule H1: Prescription-only rule for antibiotics under Drugs & Cosmetics Act (2013)
- ICMR AMR Surveillance Network: Data from 20+ state medical college labs
- HAIs in LMICs: Affect 10–30% of ICU patients (vs. 3–5% in high-income countries)
- WHO GAP-AMR: 5 strategic pillars adopted 2015; India added a 6th pillar on international leadership