In May 2015, the 68th World Health Assembly adopted the Global Action Plan (GAP) on Antimicrobial Resistance, which advocated for establishment of Antimicrobial Resistance (AMR) surveillance in member states. IEDCR initiated AMR surveillance since 2017 with technical support from CDC. At present the surveillance is mainly supported by WHO along with other development partners and government of Bangladesh. The surveillance system in Bangladesh is unique as it currently integrates both case-based and lab-based approaches, as recommended by the Global Antimicrobial Resistance and Use Surveillance System (GLASS). In the case-based surveillance, clinical cases are identified by physicians and include both epidemiological data and laboratory culture and sensitivity test results, conducted across 11 sites nationwide. Meanwhile, the lab-based surveillance, initiated in 2022, focuses solely on laboratory test data in both private (n=20) and public (n=1) laboratories.

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, please click the link below:

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