Antimicrobial resistance in India's dairy value chain: An investigation of risk factors in Haryana and Assam, India

Antimicrobial resistance (AMR) in food products represents a potential public health risk in low- and middle-income countries, yet evidence from Indian milk production systems remains limited. A cross-sectional study was conducted using 256 milk samples collected from farms and vendors in Assam and Haryana, India. AMR prevalence was high (90%) with no state-level differences. Dual AMR (both Gram-positive and Gram-negative bacteria) occurred in 48% [95% confidence interval (CI) 42–55] of samples, while multidrug resistance (MDR) was also 48% [CI 42–55], but were not significant. Dual AMR was only present in 7% of samples [CI 4–11]. AMR bacteria were detected in milk from both informal and more organised dairy systems. In multivariable analyses, none of the investigated farm-level or vendor-level predictors showed strong or consistent associations with AMR outcomes after adjustment. However, due to limited statistical power and sparse outcomes, the observed associations should be interpreted cautiously. The findings are primarily descriptive and highlight the need for larger, systematically designed studies to better understand drivers of AMR along the Indian dairy value chain. • AMR is widespread in milk from Assam and Haryana, India, including multidrug resistant isolates. • Resistance in both Gram-negative and Gram-positive bacteria detected pasteurized milk samples. • Risk-factor analyses could not identify any farm level risk factors. • Results highlight the complexity in understanding drivers of AMR along a value chain.