Overview
The Antimicrobial resistance (AMR) situation in Kerala has moved from intensive‑care units to ordinary wards and even community infections. The state’s latest antibiogram, covering all laboratory reports from 1 January 2025 to 31 December 2025, shows that drug‑resistant bacteria are now the norm rather than the exception.
Key Developments (2025)
- Data collected from 59 government and private institutions (55 labs in 14 districts) under the KARS‑Net.
- Analysis of 65,849 unique patient isolates of nine priority pathogens.
- High prevalence of ESBL production and Carbapenem resistance across Gram‑negative bacteria.
- Emergence of resistance to the last‑resort drug Colistin (0.1% overall, but rising).
- Community‑acquired pathogens like Shigella show >90% resistance to ciprofloxacin.
Important Facts
The most frequently isolated organisms were Escherichia coli (41.2%), Klebsiella spp. (25.8%), Pseudomonas spp. (10.8%), Staphylococcus aureus (8.9%) and Enterococcus spp. (8.6%). Sample sources were 46% in‑patients, 45% out‑patients and 9% ICU.
Resistance details (blood isolates):
- E. coli: 73% ESBL, 8% Carbapenem‑resistant.
- Klebsiella spp.: 68% ESBL, 43% Carbapenem‑resistant, 62% ciprofloxacin‑resistant.
- Acinetobacter: 52% Carbapenem‑resistant.
- Pseudomonas spp.: 20% meropenem‑resistant.
- Staphylococcus aureus: 33% MRSA (methicillin‑resistant).
- Enterococcus: 4% vancomycin‑resistant (VRE), 1% linezolid‑resistant.
Typhoidal Salmonella and Shigella retain low resistance to ampicillin (7‑8%) but show very high ciprofloxacin resistance (55‑93%).
Exam Relevance
Understanding Kerala’s AMR trends is vital for several GS papers. KARSAP illustrates how a state can design a surveillance‑driven health policy (GS3). The data feed into India’s National Centre for Disease Control (NCDC) system and the WHO’s GLASS, showing the link between state, national and global health governance (GS3, GS4).
High levels of ESBL and Carbapenem resistance raise questions about antibiotic stewardship, prescription practices, and public awareness—topics that appear in the Ethics and Integrity paper (GS4) and the Health‑Security component of GS3.
Way Forward
- Strengthen antimicrobial stewardship programmes in hospitals to curb irrational prescribing.
- Launch community‑level awareness campaigns on antibiotic misuse and hygiene to reduce spread of resistant community pathogens.
- Expand rapid diagnostic capacity to guide targeted therapy and limit empirical broad‑spectrum use.
- Monitor emerging Colistin resistance closely and develop alternative treatment protocols.
- Continue feeding state data into NCDC and GLASS to inform national policy and international collaboration.
Kerala’s surveillance model, built under KARSAP, can serve as a template for other Indian states aiming to tackle the growing AMR crisis.