Rising antibiotic resistance weakens ICU lifeline

The intensive care units (ICUs) in hospitals across the country are facing a dire crisis as the effectiveness of crucial antibiotics continues to diminish rapidly.

The 2023-24 antimicrobial resistance (AMR) surveillance report reveals that many powerful antibiotics are increasingly losing their effectiveness, creating significant challenges for patient recovery.

This surveillance, which began in 2017, monitors the performance of various antibiotics against different bacteria by analysing around 16,000 samples from 11 major hospitals and five diagnostics centers across the country.

The recent report, revealed on Sunday at an event in Dhaka, showed that carbapenem, one of the last resort antibiotics used in ICUs, is now ineffective in approximately 65% of cases.

Particularly, the rapid decline in the effectiveness of carbapenem to cure infections caused by two serious bacteria – Acinetobacter and K pneumoniae-- has alarmed experts.

AMR causes around 3,500 deaths daily, with over 1.2 million people dying in 2019 from antibiotic-resistant infections, according to a 2022 Lancet study.

“Most of the antibiotics have lost effectiveness and the condition is quite serious in ICU patients. If this trend continues, our ICUs will become totally ineffective soon,” Prof Zakir Hossain Habib, the lead of the surveillance and chief scientific officer at the Institute of Epidemiology, Disease Control and Research (IEDCR) told the Daily Sun.

He added that doctors must be more cautious in using antibiotics.

The 11 major hospitals under the surveillance include—Dhaka Medical College Hospital, Mymensingh Medical College Hospital, Rajshahi Medical College Hospital, Rangpur Medical College Hospital, Bangladesh Institute of Tropical and Infectious Diseases (BITID), Uttara Adhunik Medical College Hospital, Sylhet MAG Osmani Medical College Hospital, Khulna Medical College Hospital, Cox’s Bazar Medical College Hospital, Sher-e-bangla Medical College Hospital and Chittagong Medical College Hospital. Around 17 antibiotics were tested against the bacteria responsible for urinary tract infections, septicaemia, diarrhoea, pneumonia and wound infections and some other ailments.

The report also highlighted the diminishing effectiveness of ceftriaxone, a Watch Group antibiotic, which has fallen below 60% effectiveness in some hospitals. Once widely used for treating various infections, its declining potency has become a major concern, researchers said.

According to the World Health Organization (WHO), antibiotics are categorized into three groups: Access Group, used for common infections and considered relatively safe; watch group, includes antibiotics used for more severe or resistant infections; and reserve group, used for life-threatening infections when other antibiotics fail.

The IEDCR report indicates that 77% of antibiotics fall under the Watch Group, exceeding WHO’s recommendation to keep usage within 40%.

Experts note that this unregulated usage is a significant contributor to the rise of antimicrobial resistance.

The report found that linezolid, a Reserve Group antibiotic, is heavily used in ICUs, but its effectiveness has also declined to just 67%.

The report highlighted the distribution and resistance of high-priority and multidrug-resistant pathogens in 11 hospitals under surveillance, with methicillin-resistant Staphylococcus aureus (MRSA) being particularly prevalent in blood samples, especially in ICUs and general wards.

Critical bacteria like carbapenem-resistant E. coli and K. pneumoniae exhibited resistance to meropenem – a reserve group antibiotic, reaching up to 80% in some hospitals, while these bacteria also show over 90% resistance to ceftriaxone in certain locations.

Another bacterium – Acinetobacter spp. – displayed alarming carbapenem resistance, reaching up to 98% in some ICUs. Additionally, multidrug-resistant Pseudomonas aeruginosa bacterium demonstrates moderate to high resistance, particularly in ICUs, with carbapenem resistance nearing 90% in some hospitals.

To address this situation, experts emphasize the need to strengthen laboratory capabilities, ensure antibiotics are used after proper diagnostic testing, and raise awareness among physicians about responsible antibiotic use.

“We must reconsider how we use antibiotics and implement necessary reforms. Applying the right antibiotics based on sensitivity testing can improve the situation,” Prof Zakir Hossain said.