Tropical cyclone exposure linked to antibiotic resistance and disease outbreaks

Tropical cyclones mobilize pathogens, antibiotics, and resistance genes, yet nationwide organism and drug specific links to antimicrobial resistance (AMR) remain unclear. Using national surveillance data from 2017 to 2023, we estimate associations between cyclone activity and resistance by organism, antibiotic, and lag in India. Signals are large and specific, with Klebsiella showing same year co-movement with ertapenem resistance (r = 0.96), Salmonella showing a prior year association for ampicillin (r = 0.86), and Escherichia coli showing a same year association for ampicillin (r = 0.856). We then develop a cyclone informed month ahead outbreak model for 2017-2018 that integrates routine seasonality. With two alerts per state per year (~16.7% of months), precision reached 1.0 in 20/31 states, ≥0.5 in 27/31, off season silence held in 29/31, and standardized net benefit was positive in 27/31. These findings provide empirical and quantified evidence linking cyclones to antimicrobial resistance in India, as well as a practical early warning tool for climate-resilient public health.