41% of ICU patients not responding to antibiotics: IEDCR

The Institute of Epidemiology, Disease Control and Research's (IEDCR) National Antimicrobial Resistance (AMR) Surveillance has revealed that 41% of patients admitted to intensive care units (ICUs) are not responding to any available antibiotics.

The findings were unveiled at the official launch of the national AMR surveillance report at IEDCR's new building in Mohakhali today (24 November).

The report, presented by IEDCR Chief Scientific Officer Professor Dr Zakir Hossain Habib, paints a grim picture of widespread "superbugs" defying all treatment.

The case-based surveillance, conducted from July 2024 to June this year, analysed data from more than 96,477 patients across the country.

Samples collected from five ICUs were tested against 71 different antibiotics, and a significant number showed no effectiveness.

People often take antibiotics from pharmacies or quacks without proper medical guidance, and in many cases, this leads to resistance.

The IEDCR said Pan-Drug-Resistant (PDR) organisms – resistant to all antibiotics tested – were found in 7% of all samples, rising sharply to 41% in ICU samples.

Multi-Drug-Resistant (MDR) pathogens accounted for 46% of all isolates and an alarming 89% in ICU samples, it added.

Dr Habib warned, "Unregulated antibiotic consumption is driving AMR to a critical level. This is now a major public health threat.

"We have an issue with fungal infections in our ICUs. We need capacity-building in managing fungal infections. We are also finding many red zones in the wards, meaning antibiotic resistance is increasing there as well," he said.

"Save antibiotics, save yourself," he urged the public.

Dhaka leads in perilous consumption

The surveillance report revealed that Dhaka alone consumes 57% of all antibiotics used in Bangladesh.

This figure reflects the capital's high patient volume, numerous specialised hospitals, and broader access to healthcare.

Following Dhaka were Rajshahi, Chattogram, Khulna, Barishal, Rangpur and Sylhet.

Notably, high antibiotic use was also observed among patients suffering from urinary tract infections (UTIs).

The surveillance also highlighted a surge in the use of WHO Watch-Group antibiotics, essential for human medicine, rising from 77% to 90.9%.

Ceftriaxone (33%) and Meropenem (16%) remained the most frequently used antibiotics in surveillance sites, mirroring previous years' trends.

Earlier studies show worsening national trend

The new IEDCR data aligns with earlier national studies that also warned of a rapidly worsening AMR crisis.

A separate IEDCR study released in 2023 showed that antibiotic resistance in Bangladesh increased by 11% over five years, with several commonly used antibiotics losing effectiveness for up to 82% of patients compared to 71% five years ago. 

Resistance to key hospital drugs such as carbapenem had reached 84%, while 70% of urine samples showed drug-resistant bacteria.

Experts at the time warned that unnecessary prescribing — driven by patient demand, aggressive marketing, and lack of diagnostic facilities — was accelerating resistance across communities.

Children and young people most vulnerable

In another study by the National Institute of Laboratory Medicine & Referral Centre in 2023, people under 20 years showed the highest level of resistance, with 29.2% carrying organisms resistant to multiple antibiotics.

Alarmingly, infants as young as a few months were found carrying multidrug-resistant infections.

Researchers said widespread misuse of antibiotics, especially in childhood illnesses and through consumption of poultry meat treated with antibiotics, is contributing to early-life resistance.

The study also reported that 8.61% of bacteria in the country have become completely resistant to all antibiotics, dominated by Pseudomonas, Klebsiella and E. coli.

Hospital data show serious resistance inside ICUs

A separate Bangabandhu Sheikh Mujib Medical University (BSMMU) in 2023 study found that 21.5% of patients in its cardiovascular, kidney, paediatric and neonatal units were resistant to antibiotics.

Inside BSMMU's ICU, 52% of patients had multi-antibiotic-resistant infections.

Experts at the seminar warned that antibiotics used as "last resort," including Meropenem, were becoming ineffective, leaving doctors with few treatment options.

Top 10

Currently, the top 10 most frequently used antibiotics nationwide are Ceftriaxone, Cefixime, Meropenem, Ciprofloxacin, Azithromycin, Amoxicillin, Metronidazole, Cloxacillin, Piperacillin–Tazobactam and Vancomycin.

IEDCR Director Professor Dr Tahmina Shirin underscored the gravity of the situation, stating that the growing misuse is pushing the country deeper into an AMR crisis.

She noted that the IEDCR has been tracking AMR trends since 2017, building one of the country's largest databases on the issue.

"We must stop selling antibiotics without prescriptions. Public awareness is crucial," Dr Tahmina added.

She stressed that no one should take antibiotics without consulting a registered physician, warning that many patients are developing resistance due to advice from unqualified practitioners or drugstore staff.

"People often take antibiotics from pharmacies or quacks without proper medical guidance, and in many cases, this leads to resistance," she said, urging, "I strongly advise everyone not to use antibiotics based on recommendations from non-registered practitioners."

Moinul Ahsan, director of Hospitals and Clinics at the Directorate General of Health Services, said, "We have Infection Prevention and Control committees in all our hospitals, and meetings are held every Monday. However, the challenge is that hospitals are under tremendous patient pressure. During Covid, everyone used to wear masks and maintain distance – now that doesn't happen anymore."

"But in terms of antibiotic use, doctors are now much more cautious. Even in the ICU, when providing treatment, they consider antibiotic resistance and IPC before prescribing. We are continuing our work, and we hope the situation will improve," he added.

IEDCR said that among the WHO critical priority pathogens, ceftriaxone resistance has increased more in K. pneumoniae (from 40.1% to 52.2%) over 2022–2025 than in other Enterobacteriaceae. Its resistance to meropenem has also risen significantly (from 16% to 29.2%).

Since 2023, experts have been urging Bangladesh to adopt a 'One Health' framework integrating human health, agriculture, livestock, the environment, and regulation to combat resistance. 

With no new antibiotics expected soon, they stressed the urgent need to regulate antibiotic sales, expand diagnostic capacity, monitor antibiotic use in the animal sector, and strengthen public awareness.