Trends and Patterns of Antimicrobial Resistance in a Tertiary Care Hospital in Bangladesh

Introduction: Antimicrobial resistance (AMR) is a global public health issue, particularly in resource-limited, low- to middle-income countries like Bangladesh. In this study, we analyze and present four years of data on AMR from a tertiary care hospital in Bangladesh to inform policymakers and the wider community. Methods: In a retrospective cross-sectional study, we collected data for 4403 bacterial isolates reported between January 2017 and February 2020 at Mymensingh Medical College Hospital (MMCH), Bangladesh. All data were entered, cleaned, and analyzed using the software Stata Version-16.0, WHONET, a microbiology laboratory data management solution, and Quick Analysis of Antimicrobial Patterns and Trends (QAAPT), an AMR data visualization platform. Results: The bacteria were most commonly isolated from urine (71.66%, n = 3155), followed by pus (11.63%, n = 512), sputum (6.70%, n = 295), wound swabs (6.70%, n = 295), stool (1.91%, n = 84), endotracheal aspirate (1.20%, n = 53), and blood (0.20%, n = 9). Gram-negative bacteria predominated in all samples. Escherichia coli was the most common Gram-negative bacterium (31.30%, n = 1378), while Staphylococcus aureus was the most common Gram-positive bacterium (4.38%, n = 193). Antimicrobial susceptibility testing (AST) showed that multidrug resistance in Gram-negative bacteria such as E. coli, Klebsiella sp., and Acinetobacter sp. was common. S. aureus exhibited high resistance rates for beta-lactams, macrolides, and quinolones. In the urine samples, E. coli demonstrated high resistance to antibiotics like amoxicillin/clavulanic acid, ciprofloxacin, ceftriaxone, and cefuroxime (60-100%). Critical and high-priority pathogens as listed by the WHO constituted approximately 60% of the isolates. The AMR trends over three months showed increased resistance to amoxicillin/clavulanic acid for E. coli and to cefuroxime for Klebsiella sp. For S. aureus, the resistance to ciprofloxacin increased over three years, while the resistance to azithromycin decreased. Conclusions: There is a rise in bacterial resistance to the available antibiotics, with a significant prevalence of critical and high-priority pathogens in Bangladesh. We recommend vigilant AMR surveillance and stewardship programs to control the AMR in this country.