More than half of intensive care unit (ICU) patients who were admitted without difficult-to-treat drug-resistant bacteria acquired them during their hospital stay, according to two new studies by icddr,b, highlighting the need for stronger infection prevention and control measures in Bangladesh's hospitals.
The findings, published in the journals Microbiology Spectrum and Antimicrobial Resistance and Infection Control and announced on Saturday, are based on research involving critically ill adults and newborns treated at a tertiary government hospital in Dhaka.
One study analysed 373 adult patients admitted to an ICU between July 2023 and February 2024. Researchers found that 48.5% of patients were already colonised with difficult-to-treat drug-resistant Gram-negative bacteria in their gut when they arrived. Of the 198 patients who were initially free of the bacteria, 105, or 53%, acquired them during their ICU stay, suggesting substantial in-hospital transmission.
The research focused on four Gram-negative bacteria commonly linked to hospital-acquired infections: Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. These organisms are resistant to commonly used antibiotics and can cause serious illnesses, including pneumonia, bloodstream, urinary tract and wound infections.
Researchers found that mortality among ICU patients who developed culture-confirmed infections caused by these bacteria exceeded 90%.
Using whole-genome sequencing, the team also found evidence that, in some patients, the same bacterial strain that had colonised the body later caused life-threatening infections.
Dr Gazi Md Salahuddin Mamun, Assistant Scientist at icddr,b and lead author of one of the studies, said the research followed patients throughout their ICU stay while using advanced laboratory techniques to trace how resistant bacteria spread within hospitals.
"This allowed us to identify links between bacteria carried by patients and those causing subsequent deadly infections," he said.
Dr Fahmida Chowdhury, Lead of the Antimicrobial Resistance Research Unit at icddr,b and principal investigator of the studies, said hospitals should be places of healing rather than sources of potentially life-threatening infections.
"In our study, more than half of the patients who were initially free from these difficult-to-treat resistant bacteria acquired them during their ICU stay, which is deeply concerning. Strengthening infection prevention and control practices, hospital hygiene, and responsible antibiotic use is essential to better protect critically ill patients," she said.
The second study examined 363 newborns treated in a neonatal intensive care unit (NICU) between December 2023 and September 2024. It assessed the impact of enhanced infection prevention measures, including regular training for healthcare workers and cleaning staff on hand hygiene, environmental cleaning, waste management and infection control practices.
After seven months of intervention, bloodstream infections fell from 28 to four cases per 100 admissions, representing an 86% reduction. Mortality also declined from 26 to four deaths per 100 admissions.
Dr Tahmeed Ahmed, Executive Director of icddr,b, said the findings demonstrated both the scale of the challenge and the effectiveness of basic infection prevention measures.
"These studies reveal a troubling reality: patients are acquiring difficult-to-treat drug-resistant bacteria while receiving care in our hospitals, and the consequences can be devastating. At the same time, they show that strengthening basic infection prevention and control measures can dramatically reduce infections and deaths," he said.
He urged hospital authorities and policymakers to prioritise infection prevention, hospital hygiene, surveillance and responsible antibiotic use to better protect patients and help combat antimicrobial resistance.
