Genomic sequencing should extend to diverse priority pathogens for effective study and surveillance of antimicrobial resistance: a systematic review of whole-genome sequencing studies from India

Background Antimicrobial resistance (AMR) is a public health emergency in many low and middle-income countries, including India. To effectively tackle AMR, we need rapid diagnostics, effective surveillance and new antimicrobial drugs. Whole-genome sequencing of pathogens is the first definite step towards achieving these goals. Methods In this work, we review all the studies published till date that report whole-genome sequences of select priority AMR pathogens from India. We searched PubMed and Web of Science databases for the studies that involved whole-genome sequencing of AMR priority pathogens from India. For the top two highly sequenced pathogens, S. typhi and K. pneumoniae, we performed phylogenetic analyses to understand the geo-climatic distribution of genetically diverse strains. Results Our search reveals 94 studies that report 2547 unique whole-genome sequences. We find that most sequences are limited to select priority pathogens isolated from a couple of geo-climatic zones of India. Our phylogenetic analyses show that available data does not indicate systematic differences between the genomes of isolates from different geo-climatic zones. Our search also reveals complete absence of travel-related studies tracking possible movement of AMR pathogens within country. Lastly, we find very few studies that sequence AMR pathogens isolated from food, soil or other environments. Conclusion Together, these observations suggest that lndia should prioritize sequencing of diverse AMR pathogens from clinics as well as from environments and travellers rather than extending the geo-climatic range of already-sequenced pathogens. Our recommendations can be potentially valuable for other low and middle-income countries with limited resources, high prevalence of AMR and diverse geo-climatic conditions. ### Competing Interest Statement The authors have declared no competing interest.