Antibiotic resistance in Bangladesh: A systematic review

Background: Antibiotic resistance (ABR) is a worldwide problem and Bangladesh is a major contributor to this owing to its poor healthcare standards, along with the misuse and overuse of antibiotics. This systematic review was conducted to summarize the present scenario of ABR in Bangladesh, to identify gaps in surveillance, and to provide recommendations based on the findings. Methods: Google Scholar, PubMed, and Bangladesh Journals Online were searched using relevant keywords to identify articles related to ABR in Bangladesh published between 2004 and 2018. Inclusion or exclusion was based on a predefined set of criteria. The resistance of a bacterium to a given drug was presented as the median resistance (MR) and interquartile range (IQR). Results: Forty-six articles were included in this systematic review. Antimicrobial susceptibility testing was performed by disk diffusion method in 82.6% of studies, while the Clinical and Laboratory Standards Institute (CLSI) guidelines were followed in 78.3%. Data regarding the susceptibility testing method, guidelines for interpretation, and source of infection (hospital/community) were absent in 10.9%, 19.6%, and 73.9% of the studies, respectively. A high prevalence of resistance was detected in most tested pathogens, and many of the common first-line drugs were mostly ineffective. Resistance to carbapenems was low in most cases. The presence of extended-spectrum beta-lactamase (ESBL)-producing organisms was indicated by the high resistance to beta-lactams. Methicillin-resistant Staphylococcus aureus (MRSA) was identified in four studies. Three studies reported vancomycin susceptibility of enterococci, and the median susceptibility was 100%. Streptococcus pneumoniae exhibited high susceptibility to penicillin (MR 4%). Resistance data were available from only six out of the 64 districts of Bangladesh. Conclusions: A high prevalence of resistance to most antibiotics was detected, along with major gaps in surveillance and information gaps in the methodological data of the studies (susceptibility testing method, guidelines for susceptibility interpretation, source of infection). Based on the findings, we recommend appropriate initiatives to monitor and control the use of antibiotics, as well as nationwide surveillance following standardized methodologies. (c) 2019 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).