icddr,b Studies Find High Levels of Drug-Resistant Bacteria in Bangladesh ICUs

More than half of ICU patients in Bangladesh who were initially free from difficult-to-treat drug-resistant bacteria acquired them while receiving hospital care, according to two landmark studies by icddr,b. The research revealed an alarmingly high mortality rate among patients who developed these infections, while proving that rigorous infection prevention and control (IPC) measures can dramatically reduce severe illness and deaths.

Published in the journals Microbiology Spectrum and Antimicrobial Resistance & Infection Control, the studies analyzed data from 373 critically ill adult patients admitted between July 2023 and February 2024, as well as 363 neonates admitted between December 2023 and September 2024 at a public tertiary care hospital in Dhaka.

In-Hospital Transmission and High Mortality

The research, funded by the US Centers for Disease Control and Prevention (CDC), focused on difficult-to-treat resistant Gram-negative bacteria—including Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa—which cause severe bloodstream, urinary, wound, and respiratory infections.

Laboratory testing and whole-genome sequencing revealed that nearly half (48.5 percent) of adult ICU patients were colonized with these resistant bacteria in their gut. Crucially, 53 percent (105 out of 198) of patients who entered the ICU free of these organisms acquired them during their stay, indicating substantial in-hospital transmission.

Among patients who subsequently developed culture-confirmed infections from these bacteria, mortality exceeded 90 percent. Researchers noted that the high fatality rate reflects severe challenges in resource-constrained, overcrowded critical care units, including limited antibiotic treatment options and secondary hospital-acquired infections.

Dr. Gazi Md. Salahuddin Mamun, Assistant Scientist at icddr,b and lead author of the burden study, noted that whole-genome sequencing confirmed that bacterial strains silently colonizing patients were the same ones later causing fatal infections.

Dr. Fahmida Chowdhury, Lead of the AMR Research Unit at icddr,b and Principal Investigator, emphasized the need for urgent action: "A hospital should be a place of healing, not a place where patients acquire another potentially life-threatening infection. Strengthening infection prevention, hospital hygiene, and responsible antibiotic use is essential to protect critically ill patients."

Targeted IPC Intervention Yields Dramatic Reductions

While the adult ICU study highlighted the severity of antimicrobial resistance (AMR), the companion study demonstrated that hospitals can successfully reverse these trends through structured IPC protocols.

Evaluating a targeted IPC program in the hospital's Neonatal Intensive Care Unit (NICU), researchers provided baseline and monthly training to healthcare staff and cleaners on hand hygiene, environmental sanitation, waste management, and infection control.

Following seven months of sustained intervention:

• Bloodstream infections fell by 86 percent, dropping from 28 to 4 per 100 admissions.

• Mortality decreased dramatically, falling from 26 to 4 deaths per 100 admissions.

Dr. Tahmeed Ahmed, Executive Director of icddr,b, stressed that basic hygiene and surveillance must become central to national healthcare strategy. "These studies reveal a troubling reality, but they also show that basic infection prevention measures can dramatically reduce infections and deaths. Hospital authorities and policymakers must treat infection control, hygiene, surveillance, and responsible antibiotic stewardship as core patient safety priorities," he stated.