Two new studies by ICDDR,B have shown that difficult-to-treat drug-resistant bacteria are spreading within Bangladesh's ICUs, with more than half of ICU patients who were initially free from these drug-resistant bacteria acquiring them while receiving hospital care. The studies found alarmingly high mortality among patients who developed these infections but also showed that strengthening infection prevention and control practices can dramatically reduce severe infections and deaths.

The two studies analysed data from 373 critically ill adult patients admitted to the ICU between July 2023 and February 2024 and 363 neonates admitted in NICU (neonatal intensive care unit, for newborns) between December 2023 and September 2024 of a tertiary care government hospital in Dhaka. One of the studies followed ICU patients throughout their stay and used laboratory testing and whole-genome sequencing to understand how resistant bacteria spread within the hospital and how colonisation later progressed to infection. Funded by the US Centers for Disease Control and Prevention (CDC), the study focused on difficult-to-treat resistant Gram-negative bacteria, a group of bacteria that are resistant to commonly used antibiotics, making infections extremely difficult to treat. Gram-negative bacteria can cause serious infections such as pneumonia, bloodstream infections, urinary tract infections, and wound infections, especially among critically ill patients.

The study found that nearly half of the ICU patients (48.5 percent) were colonised with difficult-to-treat resistant Gram-negative bacteria in their gut. Colonisation refers to the presence of bacteria in the body without causing infection, although colonised patients remain at risk of developing disease and transmitting the organisms within healthcare settings.

Importantly, 105 out of 198 patients (53 percent), who were initially free from these resistant bacteria, acquired colonisation during their ICU stay, suggesting substantial in hospital transmission. Among patients who developed culture-confirmed infections with these difficult-to-treat bacteria, mortality was alarmingly high. More than 90 percent of patients with these infections died in ICU. Researchers note that the exceptionally high mortality observed in this study may reflect challenges in resource-constrained critical care settings, including limited treatment options.

As Dr Fahmida Chowdhury, Lead, AMR Research Unit at ICDDR, B and the principal investigator of one of the studies, said: "A hospital should be a place of healing, not a place where patients acquire another potentially life-threatening infection while seeking treatment."

While the study highlights the scale of the challenge posed by difficult-to-treat drug resistant bacteria in Bangladesh's hospitals, a second study from the same research team demonstrates that hospitals can significantly reduce infections through stronger infection prevention and control practices. Researchers provided baseline and monthly training to healthcare workers and cleaning staff on hand hygiene, environmental cleaning, waste management, and infection prevention practices, while also monitoring compliance, bloodstream infections, mortality, and colonisation.

After seven months of continued intervention, bloodstream infections fell from 28 to 4 per 100 admissions, representing an 86 percent reduction, while mortality decreased from 26 to 4 deaths per 100 admissions. So strengthening infection prevention and control measures-including hand hygiene, environmental cleaning, antimicrobial stewardship, surveillance, and safe patient care practices-can significantly reduce infections.

Together, the findings reinforce that investing in infection prevention and control is one of the most effective strategies available for combating antimicrobial resistance and protecting vulnerable patients.