Antibiotic Resistance in Bangladesh: a Systematic Review.

BACKGROUND: Antibiotic resistance (ABR) is a worldwide problem and Bangladesh contributes a lot to it owing to its poor healthcare standards along with misuse and overuse of antibiotics. This systematic review was conducted for the first time to summarize the present scenario of ABR in Bangladesh, to identify gaps in surveillance, and to provide recommendations based on the findings.

METHOD: Google Scholar, PubMed, and Bangladesh Journals Online were searched using relevant keywords to find out 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 bacteria to a given drug was presented as the median resistance (MR) and interquartile range (IQR).

RESULT: 46 articles were included in the systematic review. 82.6% used the disc diffusion method while 78.3% followed the Clinical and Laboratory Standards Institute (CLSI) guidelines. Data regarding susceptibility testing method, interpretation guideline, and source of infection (Hospital/Community) was 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. There was indication of extended-spectrum beta-lactamase (ESBL) producing organisms from a high resistance to beta-lactams. Besides, methicillin-resistant Staphylococcus aureus (MRSA) was identified in 4 studies. 3 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 only from 6 out of the 64 districts of Bangladesh.

CONCLUSION: A high prevalence of resistance to most antibiotics have been detected along with major gaps in surveillance and information gaps in the methodological data (susceptibility testing method, susceptibility interpretation guideline, source of infection) of the studies. Based on the findings, we recommend appropriate initiatives to monitor and control the use of antibiotics, as well as nationwide surveillance following standardized methodologies.