Molecular Surveillance of Antimicrobial Resistance in Human Clinical Isolates: A Clinician Scientist Growth Journey from Rural Gujarat, India

BackgroundAntimicrobial resistance (AMR) represents one of the most serious threats to global public health, with a disproportionate burden borne by low- and middle-income countries. Rural healthcare settings in India remain under-represented in molecular AMR surveillance despite high antimicrobial use and limited diagnostic capacity. ObjectivesTo describe longitudinal phenotypic and molecular AMR patterns in clinical bacterial isolates from a rural district hospital in Gujarat, India, and to assess the feasibility of clinician-led molecular surveillance in a resource-limited setting. MethodsA retrospective observational study was conducted on 242 non-duplicate discarded clinical bacterial isolates collected between January 2021 and August 2025 at Banas Civil Hospital, Palanpur, Gujarat. Antimicrobial susceptibility testing was performed according to Clinical and Laboratory Standards Institute guidelines (CLSI M100, 31st edition) using Kirby-Bauer disk diffusion and broth microdilution methods. Molecular detection of blaCTX-M, blaNDM, blaOXA-48, mecA, and vanA resistance genes was carried out using polymerase chain reaction, with confirmation by Sanger sequencing. Data were analysed using R software (version 4.3.2). ResultsThe most common pathogens were Escherichia coli (38%), Klebsiella pneumoniae (26%), and Pseudomonas aeruginosa (17%). Resistance to third-generation cephalosporins was high in E. coli (64%) and K. pneumoniae (59%). Carbapenem resistance peaked at 17% in 2024. Molecular analysis identified blaCTX-M in 42% of Gram-negative isolates, while blaNDM and blaOXA-48 were detected in 11% and 7%, respectively. Genotype-phenotype concordance exceeded 80%. Ethical ApprovalEthical approval for the study was obtained from the Institutional Ethics Committee of Banas Medical College and Research Institute, Palanpur, Gujarat, India. No patient identifiers were accessed, and no patient interviews, direct contact, or additional specimen collection were performed for research purposes. ConclusionThis study demonstrates a substantial burden of ESBL- and carbapenemase-mediated antimicrobial resistance in rural Gujarat. Clinician-led molecular surveillance using discarded clinical samples is feasible and essential for guiding empirical therapy and strengthening antimicrobial stewardship in resource-limited settings