In May 2015, the 68^th World Health Assembly adopted the Global Action Plan (GAP) on Antimicrobial Resistance. IEDCR has been conducting AMR surveillance since 2017 with technical support from US-CDC and WHO to find out the status of Antimicrobial Resistance in Bangladesh. In February 2020, with the suggestion of National technical committee, IEDCR is selected as the Sectoral AMR Surveillance Coordination Center for human health and also with the approval of Director General of Health Services, IEDCR has been selected as the National Reference Laboratory for human health for national AMR surveillance. The Surveillance conducted in Bangladesh is unique in a sense that it is at present a combination of both case-based and lab-based surveillance. Case based Surveillance activities is being conducted in 11 sites all over Bangladesh. From 2022, Lab-Based Surveillance has been initiated. 21 branches of different private and public laboratories have been included in this lab-based surveillance.

From 2017 to June 2023, a total of 34,340 samples were collected, which included 49% (n= 16943) from outpatient departments, 39% (n=13349) from in-patient departments and the rest, 12% (n= 4048) from intensive care units. The highest number of samples (15,973) were of urine (47%) (Fig 6), however, wound swabs were found to provide maximum positive cultures (57%) (Fig 7).

The growth in different samples shows E. coli, Salmonella spp., P. aeruginosa, K. pneumoniae and V. cholerae are the highest frequent organisms (Fig 8).

Highlights:

• E. coli was the most isolated organism in the laboratory

• Acinetobacter spp., P. aeruginosa, and K. pneumonia were found to be more resistant

• SDG (Sustainable Development Goals) AMR indicator ESBLs (extended-spectrum beta-lactamases) E. coli in blood was 31% and another indicator, MRSA (methicillin-resistant Staphylococcus aureus) was 70%.

• The gram-positive bacteria were more susceptible to linezolid and nitrofurantoin (in case of urine samples)

• The gram-negative bacteria were found more susceptible to amikacin, imipenem, meropenem and fosfomycin (in case of urine).

• Although being the top listed used antibiotic, susceptibility to ceftriaxone and cefixime was poor, which further decrease over time.

• MDR organisms (resistant to at least one antibiotic from one group, total 3 or more groups) in case-based surveillance had increased over time (2017 to 2023) from 71% to 82%. More MDR pathogens were observed among Acinetobacter spp. followed by Pseudomonas aeruginosa.  

• Susceptibility increased towards clindamycin and in linezolid, although these are commonly used.

To see the antibiogram and detailed information (including live AMR Onehealth dashboard), please click the link below:

-- https://www.iedcr.gov.bd/site/page/79ff9b37-67f4-4769-a0b6-ba96faa8ee36/-