icddr,b finds widespread drug-resistant pathogens, high risk for newborns

A study by the icddr,b has revealed widespread colonisation with drug-resistant pathogens in Bangladesh, with alarming levels among newborns.

Over 81% of babies in neonatal ICUs were colonised with carbapenem-resistant Klebsiella pneumoniae, mostly acquired in hospitals.

High levels of resistant bacteria were also found in communities and adult ICUs, raising infection risks and prolonging hospital stays.

Researchers urged stronger infection control and rational antibiotic use to curb the spread.

Findings from the'' multi-country Antibiotic Resistance in Communities and Hospitals (ARCH)'' study were presented on Thursday at a dissemination seminar titled "Addressing Antimicrobial Resistance in Bangladesh: Insights from the ARCH Study" at icddr,b's Sasakawa Auditorium, Mohakhali, Dhaka.

The study was supported by the US Centers for Disease Control and Prevention (CDC) and The Task Force for Global Health (TFGH).

Colonisation refers to the presence of bacteria in or on the body without causing immediate disease, yet these bacteria can spread and later trigger infections that are extremely difficult to treat.

ARCH 1.0, conducted in 2019, uncovered high levels of resistant bacteria among both healthy individuals in communities and hospitalised patients. Extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) were highly prevalent in both communities (78%) and hospitals (82%). The prevalence of Carbapenem-resistant Enterobacterales (CRE) was significantly higher among hospitalised patients (37%) compared to community members (9%).

A notable finding was the presence of Colistin-resistant Enterobacterales (ColRE), in 11% of community members and 7% of hospital patients. Additionally, approximately one in five participants carried methicillin-resistant Staphylococcus aureus (MRSA). Whole-genome sequencing of more than 2,600 isolates revealed significant diversity among resistant bacteria, indicating that antibiotics effective against one strain may not work against another.ARCH 2.0 highlighted critical risks for newborns and ICU patients.

In NICUs, 81% of babies were colonised with carbapenem-resistant Klebsiella pneumoniae (CR-Kpn), with 70% acquiring it after 48 hours in hospital—evidence of hospital-acquired spread. In adult ICUs, 60% of patients carried CRE, facing higher infection risks and longer hospital stays.

The study also tracked mother–child pairs to understand transmission and long-term risks. Around 40% of infants were colonised with CRE and nearly 90% with ESCrE within their first year of life.

Babies who stayed in hospital for more than 72 hours after delivery showed the highest burden of colonisation. By their first birthday, more than 80% of these infants had received at least one course of antibiotics, raising concerns about the impact of early antibiotic exposure on microbiome health and resistance patterns.

Encouragingly, ARCH demonstrated that infection prevention and control (IPC) interventions, such as strengthening hand hygiene among healthcare workers and improving environmental cleaning, can substantially reduce colonisation with resistant organisms and lower bloodstream infection rates in NICUs. 

On the occasion, Prof Dr Md Sayedur Rahman, Special Assistant Ministry of Health and Family Welfare, who joined online as chief guest, said, "I find the findings extremely alarming yet valuable, and they will help us fine-tune our strategies and interventions. We are fully committed to addressing the growing threat of antimicrobial resistance. 

Dr Tahmeed Ahmed, executive director of icddr,b, said, "We have successfully controlled the sale of sedative drugs without prescription in the past. We must impose the same restrictions on stronger antibiotics to limit misuse and contain the epidemic of antimicrobial resistance. It is a multisectoral problem that requires a health systems approach."

He also stressed taking action based on the wide range of evidence that are already available." 

Brian Wheeler, acting country director, US CDC said, "I thank icddr,b and the ARCH team for the amazing work that has been done. I look forward to supporting the studies ongoing at icddr,b and within the government. This is a complex problem that is global in nature, and the solutions are multifaceted.

"Each comes with a cost, which makes this not only a scientific issue but also a matter of health economics and policy."