Difficult-to-treat drug-resistant bacteria are spreading within intensive care units (ICUs) in Bangladesh, with more than half of patients who were initially free from these pathogens acquiring them during hospital care, according to two new studies by icddr,b.
The studies, published in the journals Microbiology Spectrum and Antimicrobial Resistance & Infection Control, found an alarmingly high mortality rate among patients who developed these infections.
However, the research also demonstrated that strengthening infection prevention and control (IPC) practices can dramatically reduce severe infections and deaths.
Led by researchers from icddr,b, the studies analysed data from 373 critically ill adult patients admitted to the ICU of a tertiary care government hospital in Dhaka between July 2023 and February 2024, as well as 363 neonates in the NICU between December 2023 and September 2024.
High transmission and 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.
These bacteria are resistant to commonly used antibiotics and can cause serious conditions such as pneumonia and bloodstream, urinary tract, and wound infections.
The findings revealed that 48.5 per cent of ICU patients were colonised with these bacteria in their guts. Significantly, 105 out of 198 patients (53 per cent) who were initially free from the bacteria acquired colonisation during their ICU stay, suggesting substantial in-hospital transmission.
Among patients with culture-confirmed infections, the mortality rate was exceptionally high, with more than 90 per cent of such patients dying in the ICU. Researchers noted that this may reflect challenges in resource-constrained settings, including limited treatment options and overcrowding.
Dr Gazi Md Salahuddin Mamun, Assistant Scientist at icddr,b and lead author of the burden paper, explained that the team used laboratory testing and whole-genome sequencing to track how bacteria spread.
The sequencing provided evidence that the same bacterial strain present during colonisation later caused infection in some patients, indicating a progression from silent carriage to life-threatening disease.
“A hospital should be a place of healing, not a place where patients acquire another potentially life-threatening infection,” said Dr Fahmida Chowdhury, Lead of the AMR Research Unit at icddr,b and principal investigator of the study.
Success in prevention
A second study by the team offered a solution, demonstrating that a targeted infection prevention and control (IPC) programme in a Dhaka NICU could significantly reduce risks. By providing training on hand hygiene, environmental cleaning, and waste management, researchers saw bloodstream infections fall from 28 to 4 per 100 admissions- an 86 per cent reduction. Mortality also decreased from 26 to 4 deaths per 100 admissions.
Dr Tahmeed Ahmed, Executive Director of icddr,b, described the reality as “troubling” but noted that the studies show healthcare facilities are not powerless.
“Hospital authorities and policymakers must treat infection prevention, hospital hygiene, surveillance, and responsible antibiotic use as core patient safety priorities,” Dr Ahmed said.
Together, the findings of the two studies reinforce that strengthening the IPC programme is one of the most effective strategies available for combating antimicrobial resistance and protecting vulnerable patients.
