India shows lower MRSA, VRE rates than US, Europe despite high colonisation

The National Centre for Disease Control (NCDC) has clarified claims made in a study published in The Lancet, which reported a high prevalence of multidrug-resistant organisms (MDROs) among Indian patients undergoing ERCP procedures, saying the findings reflect colonisation, not infection.

They also stated that the data pertained to a high-risk clinical cohort rather than the general population.

The international, multicentre cross-sectional study, conducted across tertiary care centres in the Netherlands, India, Italy, and the USA, reported that 83.1 per cent of Indian ERCP patients were colonised with at least one MDRO.

"Careful interpretation of the findings and data reflects colonisation, not infection," official sources at NCDC said.

"However, colonisation indicates only the presence of organisms and does not imply clinical infection or treatment failure," an official clarified.

NCDC officials noted that "these findings pertain to a highly specific group of patients who already have multiple comorbidities, frequent healthcare exposure and higher antibiotic use. They cannot be generalised to the broader Indian population or routine healthcare scenarios."  Contrary to concerns of widespread antimicrobial resistance (AMR), the study also indicates that India recorded significantly lower prevalence of methicillin-resistant Staphylococcus aureus (MRSA) (1.4 per cent) and vancomycin-resistant Enterococci (VRE) (7.4 per cent) compared to the US and parts of Europe, signalling the effectiveness of containment strategies for gram-positive infections in the country.

Experts further pointed out that the study does not report higher ERCP-associated infection or mortality risk among Indian patients, reinforcing that high colonisation rates do not necessarily translate into adverse clinical outcomes.

The NCDC experts added that certain comparisons drawn between India and countries with lower infectious disease burdens may not reflect contextual realities. Microbial resistance trends vary across regions and must be understood in light of differential population density, morbidity patterns, and healthcare access. The study itself recommends region-specific prevention strategies, they noted.

Officials cautioned against linking the findings to alleged excessive antibiotic use in India, clarifying that cross-sectional studies, such as the current one, cannot establish causation. Moreover, the study does not assess or report community-level spread of MDR organisms.

In conclusion, an NCDC expert reiterated the importance of interpreting such scientific data within the clinical context.

"While antimicrobial resistance remains a global concern, this study should not be misrepresented as a marker of systemic failure. The findings underscore the need for continued surveillance, infection control and stewardship, not alarmism," the official said.