Antimicrobial resistance (AMR) continues to pose a serious threat to global health systems, particularly in high-burden countries like India. The challenges it presents to surgical treatment are complex and evolving, demanding both robust surveillance and strategic preventive interventions. In this interview, Dr. Camilla Rodrigues from Hinduja Hospital shares the current epidemiological landscape of AMR in India, discusses the risks it poses to surgical patients, and outlines successful approaches her center has implemented to mitigate these threats—particularly through systematic MRSA decolonization and strengthened infection control protocols.

Q1. Could you introduce the current epidemiological status of antimicrobial resistance (AMR) in India? How does AMR pose threats and challenges to surgical treatment?

Dr. Camilla Rodrigues:

The Government of India, through the Indian Council of Medical Research (ICMR), has initiated an important active surveillance program for several years now  known as AMRSN—the Antimicrobial Resistance Surveillance Network. The surveillance  provides yearly data on resistant organisms, with a strong focus on gram-negative bacteria, though gram-positive organisms are also included. These data are accessible online and represent isolates collected from across the entire country, ensuring broad representation. This surveillance effort is a significant step forward in understanding the AMR burden in India.

In terms of surgical perioperative prophylaxis  , AMR poses a threat.  Without surgical care bundles and proper antimicrobial stewardship in place, we should not escalate to higher antibiotics. The operative setting must be optimized—from preoperative skin preparation to maintaining operating theatre (OT) hygiene  and discipline and assessing patient risk factors—to reduce infection rates without relying solely on antibiotic escalation. Antibiotics for Prophylaxis indications should differ from those reserved for empiric and targeted therapy

https://iamrsn.icmr.org.in/index.php/amrsn/amrsn

Q2. Faced with the current threats and challenges of AMR to surgical treatment, do you think there is a need to change the preventive measures for surgical AMR? What kind of the preventive measures particularly need to be changed?

Dr. Camilla Rodrigues:

Absolutely. It is critical to first focus on optimizing non-antibiotic preventive measures. These include meticulous skin preparation, strict operating theatre protocols, using the recommended choice for antibiotic prophylaxis and stopping perioperative prophylaxis within 24 hrs and most importantly, patient risk assessment prior to surgery including glycemic control.

In our hospital, for example, we screen patients—especially those referred from other hospitals or those with risk factors—for MRSA colonization. If they test positive, we initiate decolonization using mupirocin. We do not assume the treatment has worked—we verify the decolonization status again before proceeding to surgery. This layered approach ensures that we reduce the risk of post-operative infections without over-relying on antibiotics.

Q3. Could you share some successful experiences of your center, Hinduja Hospital, in the prevention and control of surgical AMR?

Dr. Camilla Rodrigues:

At Hinduja Hospital, In particular, one of our studies  performed by our head of Orthopedic surgery  demonstrated that post-surgical MRSA infection rates were extremely low—virtually nil—among patients who underwent successful decolonization. This proves that targeted decolonization using mupirocin is highly effective.

While hospital websites may not provide detailed information on this, many of our findings are published and referenced in presentations. For example, we also have publications on SSI (Surgical Site Infection) rates and ESBL (Extended-Spectrum Beta-Lactamase) surveillance as well CRE colonisation. All of these resources are accessible online, and I encourage others to review them to understand the strategies we’ve implemented.

Dr. Rodrigues’ insights reflect the urgent need to integrate real-time surveillance, targeted screening, and preventive protocols into surgical practice to combat AMR in India. Her team’s results at Hinduja Hospital underscore how structured, evidence-based interventions—especially MRSA screening and decolonization—can lead to measurable reductions in surgical site infections without depending on ever-stronger antibiotics.

Head of Department of Lab Medicine, Consultant Microbiologist, Chairperson Infection Control Committee of Hinduja Hospital, Mumbai, India