Bangladesh’s intensive care units (ICUs) are facing an alarming rise in antibiotic-resistant infections, with 89% of bacteria detected in ICU patients resistant to multiple antibiotics, according to the latest national antimicrobial resistance (AMR) surveillance report, underscoring a growing threat to critically ill patients.
The findings, published in the “Antimicrobial Resistance Surveillance Bangladesh 2025” report by the Institute of Epidemiology, Disease Control and Research (IEDCR), show that 41% of ICU isolates are suspected to be pan-drug resistant (PDR)-meaning treatment options are extremely limited.
The report, based on samples collected from medical college hospitals across Bangladesh, found that while 46% of bacteria identified nationwide were multidrug-resistant (MDR), the rate nearly doubled to 89% in ICUs, highlighting the vulnerability of intensive care settings.
ICU Emerges as Resistance Hotspot: Health experts say ICU patients are particularly susceptible because they often rely on ventilators, urinary catheters and other invasive medical devices while receiving broad-spectrum antibiotics from the outset of treatment.
Analysis of 15,844 prescriptions found that 48% of all antibiotics used in hospitals were administered in ICUs, compared with 44% in general wards and only 8% in outpatient departments.
The surveillance also identified high levels of multidrug resistance among major hospital pathogens, including Enterococcus faecium (74%), Acinetobacter (65%), Klebsiella pneumoniae (53%), and Escherichia coli (52%).
Experts Warn of Escalating Threat: “Surveillance data show that antimicrobial resistance is increasing steadily in Bangladesh, particularly in intensive care units where multidrug-resistant organisms and resistance to commonly used antibiotics have reached worrying levels,” Prof. Dr. Zakir Hossain Habib, Chief Scientific Officer (Virology) at IEDCR and chief editor of the AMR surveillance report, told The Daily Industry.
He noted that antibiotic susceptibility analyses indicate the number of effective treatment options is shrinking, making stronger infection prevention and control (IPC) measures essential.
Dr. Ariful Bashar, Consultant in Medicine at the Infectious Diseases Hospital, said weak implementation of infection prevention protocols remains a major challenge.
“Although Bangladesh has IPC guidelines, enforcement is often inadequate. Unnecessary entry into ICUs, poor compliance with hygiene practices, and insufficient monitoring of medical equipment increase the risk of transmitting resistant bacteria between patients,” he told The Daily Industry.
Rational Antibiotic Use Urged: The IEDCR report recommends strengthening Antimicrobial Stewardship Programmes (ASP) in hospitals to promote rational antibiotic use, reduce unnecessary prescriptions, and encourage treatment based on laboratory test results.
It also found that 90.9% of antibiotics used belonged to the World Health Organization’s ‘Watch’ category, which requires careful monitoring because of their higher potential to drive resistance. By contrast, ‘Access’ antibiotics, recommended for common infections, accounted for only 9.7% of prescriptions, while ‘Reserve’ antibiotics remained below 1%.
Prof. Dr. Shah Monir Hossain, former Director General of the Directorate General of Health Services (DGHS), said irrational antibiotic use, self-medication and failure to complete prescribed treatment courses are accelerating antimicrobial resistance in Bangladesh.
“Improving hospital infection control systems and promoting responsible antibiotic use are essential to slowing the spread of resistant bacteria,” he told The Daily Industry.
Health experts also called for broader community-level surveillance alongside hospital monitoring to better understand the true scale of antimicrobial resistance and guide future public health interventions.
