World Health Organization Access, Watch, and Reserve Framework for the Treatment of Priority Pathogens: Evidence from Antibiotic Susceptibility Profile of Pus Isolates from Patients at a Tertiary Care Center

Introduction: The growing challenge of antimicrobial resistance represents one of the most critical threats to modern medicine. Misuse and overuse of antibiotics have contributed significantly to the selection of multidrug-resistant organisms, making once-treatable infections difficult to treat. In response, the World Health Organization introduced the Access, Watch, and Reserve (AWaRe) framework as a strategic tool to promote responsible antibiotic use and reduce the risk of resistance development. Materials and Methods: This was a retrospective and cross-sectional study conducted in the Department of Microbiology, S. N. Medical College Agra, India. A total of 623 pus samples were studied from July 2024 to December2024. Pus samples collected were sent immediately to the microbiology department. Identification and antibiotic susceptibility of isolates was done using the standard microbiological techniques. Results: Over half of the isolates, 58.3% (346) were Gram-negative while 247 isolates were Gram-positive 21.7%. Klebsiella pneumoniae and Pseudomonas aeruginosa were commonly isolated (23.6% and 19.0%, respectively) among Gram-negative bacteria while Staphylococcus aureus in Gram-positive (35.4%). Gram-negative bacteria exhibited limited resistance to carbapenems but strong resistance to fluroquinolones and aminoglycosides. Among gram-positive isolates most common resistance was to fluroquinolones followed by macrolides. Conclusions: The findings suggest that for most organisms especially Gram-positive we can adhere to access group. For Enterobacterales, we must use the Watch group. Nonfermenters such as Acinetobacter are more resistant, requiring treatment with reserve antibiotics. This pattern also underlines the utility of hospital antibiogram for determining the antimicrobial policy making and guidelines for empirical use.