Situation of antibiotic resistance in Bangladesh and its association with resistance genes for horizontal transfer

Abstract

2The study investigated the spectrum of antibiotic resistance and the associated genes for 3 aminoglycoside, macrolide and ESBL class of antibiotics using clinical isolates. A total of 430 4 preserved bacterial strains (Acinetobacter baumannii, n= 20; Pseudomonas aeruginosa, n= 26; 5 Klebsiella pneumoniae, n= 42; E.coli, n= 85; Staphylococcus aureus, n= 84; Salmonella Typhi, 6 n= 82; Enterococcus spp., n= 27; Streptococcus pneumoniae, n= 36 and CNS, n= 28) were 7 examined. The strains were isolated from patients admitted to various tertiary hospitals of Dhaka 8 city between 2015 and 2019 with either acute respiratory infections, wound infections, typhoid 9 fever or diarrhea. The isolates were reconfirmed by appropriate microbiological and biochemical 10 methods. Antimicrobial susceptibility tests were done using Kirby-Bauer disk diffusion approach. 11PCR amplification using resistance gene-specific primers for aminoglycoside, macrolide and 12 ESBL class of antibiotics was done and the amplified products were confirmed by Sanger 13 sequencing. Of the total isolates, 53% came out as MDR with 96.6% of E. coli and 90% of 14 Staphylococcus aureus. There was a year-wise gradual increase of MDR isolates from 2015-2018 15 and by 2019 the increase in MDR isolates became almost 2-fold compared to 2015. Among the 16 five ESBL genes investigated, CTXM-1 came out as the most prevalent (63%) followed by NDM-17 1 (22%) and E. coli isolates were the predominant reservoir of these genes. ErmB (55%) was the 18 most frequently detected macrolide resistance gene, whereas aac(6)-Ib (35.44%) was the most 19 prevalent aminoglycoside resistance gene and these genes were most prevalent in E. coli and P. 20 aeruginosa isolates, respectively. CTXM-1 and ErmB (16.66%) were the most frequent partners 21 of coexistence followed by CTXM-1 and aac(3)-II.22 24 Antimicrobial resistance (AMR) is becoming a very challenging problem worldwide. Solving the 25 AMR problem should be the priority of global efforts. Nosocomial infections have been 26 recognized as the hub for thriving multidrug resistant (MDR) pathogens. It is estimated that around 27 8.7% of the hospitalized patients worldwide develop nosocomial infections which is the leading 28 cause of surgical failure, transplant rejection, treatment failure, increased costs and even deaths 29 [1]. Numerous reports suggest that absolute numbers of infections due to resistant microbes are 30 increasing globally [2-4]. It is conservatively estimated that at least 2 million illnesses and 23,000 31 deaths had been caused by antibiotic resistant organisms per year in the USA [5]. The present trend 32 predicts that infections by resistant bacterial pathogens may cause up to 10 million deaths/year -33 more than any other causes -by 2050 and like the most global issues, the problem is inequitably 34 distributed, with approximately 90% of the predicted deaths are estimated to happen in Asia and 35 Africa [6]. Additionally, treatment of the patients infected with resistant pathogens is associated 36 with...

Antimicrobial resistance and virulence characteristics of Vibrio vulnificus, Vibrio parahaemolyticus and Vibrio harveyi from natural disease outbreaks of marine/estuarine fishes

“…Absence of other genes in the presence of resistance phenotype warrant future research targeting more diverse AR genes among vibrios from marine/estuarine aquaculture environments. However, such discrepancies between AMR phenotypes and prevalence of ARGs has been observed by different authors (Dang et al, 2006;Kitiyodom et al, 2010;Raissy et al, 2012;Safain et al, 2020), which might be due to the presence of other resistance mechanisms which were not investigated in the present study. Another possible explanation is that resistance phenotypes can be expressed upon the stimulation of many different genetic factors (Van et al, 2020).…”

Bacterial communities associated with the surfaces of the fresh fruits sold around Dhaka Medical College and Hospital and their anti-microbial profiles

“…According to a recent study, Escherichia coli is a predominant reservoir of CTX-M15A gene. 29 CTX-M15A gene was also found previously in poultry, wild birds as well as in environmental water in Bangladesh. 30,31 These findings strengthen the fact that AmpC β-lactamase gene producing organisms can cause community acquired and hospital acquired infections.…”

Hospital Perinatal Transmission Dynamics of Antimicrobial Resistance, Bangladesh, 2020

“…[62] However, the situation in the delivery ward is unlikely to be unique in Bangladesh given high levels of antibiotic resistance reported across a variety of settings. [63,64] Reasons for liberal antibiotic use in Bangladesh include lack of understanding of antibiotic function, low awareness of antibiotic resistance, overemphasis on use of antibiotics for prevention, and a perception of antibiotics as a symbol of power. [65] Additionally, this tertiary care facility does not have a functioning microbiology laboratory or infectious disease consultant, limiting the ability to select appropriate antibiotics based on antibiograms or culture results or seek expert consultation.…”