International Journal of Scientific Reports

Amran MS et al. Int J Sci Rep. 2024 May;10(5):176-183

http://www.sci-rep.com

pISSN 2454-2156 | eISSN 2454-2164

Review Article

DOI: https://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20240982

Antibiotic resistance situation in Pabna, Bangladesh: a review

M. Shah Amran1*, M. Nadim Ibrahim2, Fatema Tuzzahura Amanna3

1Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Dhaka, Bangladesh

2Department of Pharmacy, Pabna University of Science and Technology, Pabna, Bangladesh

3Department of Pharmacy, Varendra University, Rajshahi, Bangladesh

Received: 10 February 2024

Revised: 10 March 2024

Accepted: 11 March 2024

*Correspondence:

Dr. M. Shah Amran,

E-mail: amrannms@du.ac.du

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Antibiotic abuses and overuses are factors in the global issue of antibiotic resistance (ABR) which is becoming more acute in densely populated urban areas. To offer a concise summary of the present status of ABR in Pabna city, identify any deficiencies and generate recommendations based on findings, a comprehensive analysis was performed. We conducted a search for articles related to ABR published between 2003 to 2022 using search engines such as Google Scholar, PubMed, online and offline journals in Bangladesh. In the past, it was possible to determine the median and interquartile ranges of an organism’s ABR. Forty-two research articles were included in this review. For determining antibiotic susceptibility, approximately 95.96% of the investigations used the disk diffusion method, and about 91.98% followed the clinic and laboratory standards institute’s recommendations. However, information about susceptibility testing procedures and the source of infections-whether they were hospital-based or community-based- was conspicuously absent from about 11.19%, 12.62%, and 92.24% of the study studies, respectively. Many of the diseases studied exhibited high levels of resistance, and traditional first-line antibiotics were largely ineffective. Most of the patients displayed only mild resistance to carbapenem. A developing trend in ABR across the majority of antibiotic classes was also revealed by our findings, in addition to severe monitoring and informational gaps.

Keywords: ABR, Pathogens, Insufficient antibiotics, Pabna

INTRODUCTION

The ability of antibiotics to save lives is universally known. However, some argue that they are medications specifically designed to target particular disease-causing microbes.1

ABR presents a global health concern due to the overuse and inappropriate application of antibiotics, compounded by inconsistent monitoring practices. In various countries, epidemiological differences further complicate the issue. Despite past successes in combating infectious diseases, the continuous and substantial increase in antimicrobial resistance (AMR) has eroded confidence over the last three decades.2,3 For several reasons, with one of the most important ones being the availability of resistance genes brought on by the incorrect use of antibiotics, the idea of promoting ABR is appealing.4 AMR has a variety of negative effects, including increased healthcare expenditures, a rise in the incidence of illnesses, and a rise in the number of fatalities. These effects affect both developed and developing countries. In South Asia and Africa, multidrug resistance (MDR) is thought to be responsible for about 45% of fatalities, according to a world health organization (WHO) research. Bangladesh, a developing country in South Asia, is experiencing a sharp rise in ABR. There is a common claim that when doctors in Bangladesh prescribe antibiotics to patients, they usually make educated estimates.6-8

According to the most recent reports, a potential increase of 10 million deaths by 2050, along with substantial economic losses globally, if effective measures are not taken to address this threat. The present review focuses on the available data regarding ABR situations in Pabna, as reported in various published articles. The ultimate objective is to offer recommendations for future initiatives and guide policymakers toward an optimal strategy to reduce the prevalence of ABR.9

METHODS

In order to perform this research, we devised specific methods that were focused on examining the level of ABR in Bangladesh, notably in Pabna. The goals of this review included a variety of research questions, including one that looked into the causes of the ABR epidemic in Pabna. To find pertinent literature on ABR in Pabna, extensive searches were conducted between 2004 and 2022 using search engines including Google Scholar, PubMed, BioMed, and Banglajol. The WHO global priority list was taken into consideration as the review covered a variety of pathogens listed in the publications. Antibiotics, resistance, Pabna, and Bangladesh-related keywords were included as part of a review strategy. The information received from various sources was arranged in tabular form.

The resistance patterns of the pathogens were recorded, and for each bacterium, the resistance pattern was presented using median and interquartile range values. Data analysis was conducted using Microsoft excel 2016.

DISCUSSION

The study presented the resistance pattern for each bacterium using the median and interquartile range values.10 It documented the resistance patterns of diverse diseases. In order to analyze the data, Microsoft Excel 2016 was used. The research’s main area of interest was Pabna, Bangladesh.11,12 The disc diffusion method was used in 96.16% of the investigations (34 of the 44), out of the many susceptibility testing techniques used. The criteria for antimicrobial susceptibility testing from the Clinical and Laboratory Standard Institute (CLSI) were used to interpret the bulk of the results (94.31%, or 36 out of 44). There were 44 studies, and 18.51% (7 out of 44) examined urine samples from urinary tract infections (UTIs), and 16.07% (6 out of 44) examined blood and gastroenteritis culture samples. An overview of these studies has been given in Table 1.

9 of the 14 pathogens chosen for analysis had median and interquartile range values that were determined as shown in Table 2. In some cases, there was insufficient data to calculate the interquartile range (IQR), which normally requires at least three data points.

Escherichia coli, which is the most common culprit in urinary tract infections (UTIs), was the subject of investigation in 21 research articles. The results pointed to a significant resistance to several commonly prescribed drugs, including ampicillin (with a resistance rate of 96.5%, ranging from 92% to 100%), amoxiclav (with a resistance rate of 65.5%, ranging from 52% to 92.9%), ciprofloxacin (with a resistance rate of 65.2%, ranging from 59.4% to 80.85%), and co-trimoxazole (with a resistance rate of 79%, with no specified IQR).13-21

For other microorganisms responsible for UTIs, similar trends were observed. In the case of Klebsiella spp., resistance rates of 100% (ranging from 99.98% to 100%), 54.85% (ranging from 10.7% to 85.3%), 66.4% (ranging from 49.6% to 82.9%), and 76.9% (ranging from 38% to 88.5%) were recorded for ampicillin, amoxiclav, ciprofloxacin, and co-trimoxazole, respectively.22,23

In the case of Pseudomonas spp. isolates, 66.5% (with a range of 39.1% to 98.9%) displayed resistance to co-trimoxazole, while Enterococcus spp. isolates showed non-susceptibility in 88.5% of cases (with a range of 84.2% to 99%). Both Enterococcus spp. isolates and Pseudomonas spp. isolates exhibited resistance to ciprofloxacin, with 62% (ranging from 74.3% to 97.7%) for Enterococcus spp. and 69.3% (ranging from 24% to 88.3%) for Pseudomonas spp. These findings indicated the presence of extended-spectrum beta-lactamase (ESBL) production, as evidenced by the high resistance to beta-lactam antibiotics.

For E. coli, the resistance rates to cefotaxime, ceftazidime, and ceftriaxone were 54.4%, 62.3%, and 49%, respectively. In contrast, Klebsiella spp. exhibited higher resistance rates of 98.4%, 81.5%, and 76% to these antibiotics, respectively.

Conversely, carbapenem antibiotics demonstrated significant efficacy against the majority of the previously mentioned microorganisms. Only a minimal 1.3% (with a range of 0% to 9.9%) of E. coli, 0% (with a range of 0% to 13.5%) of Klebsiella spp., 15.4% (with a range of 6.4% to 39.6%) of Pseudomonas spp., and 31.9% (with a range of 11.6% to 58.7%) of these bacteria exhibited resistance to imipenem. Resistance to meropenem was observed in 12.3% (with a range of 0.2% to 36%).

Isolates of Streptococcus pneumoniae obtained from pneumonia patients were found to be highly susceptible to penicillin (with a resistance rate of 3%, ranging from 2.5% to 18%) and ampicillin (with a resistance rate of 0%, ranging from 0% to 16%). In contrast, Staphylococcus aureus displayed substantial resistance to penicillin, ampicillin, co-trimoxazole, and amoxicillin (with resistance rates of 89.7%, 82.8%, 53.2%, and 66.5%, respectively).

Methicillin-resistant Staphylococcus aureus (MRSA) was detected in four studies through oxacillin susceptibility testing, identifying 93 out of 199 isolates as MRSA. In the case of Salmonella spp., eight studies reported their antibiotic resistance patterns. These bacteria exhibited high susceptibility to cefixime (with a resistance rate of 0%, ranging from 0% to 9.5%) and ceftriaxone (with a resistance rate of 2%, ranging from 0% to 9.2%). For Shigella spp. isolates, only 9.9% (with a range of 2.4% to 18.8%) were resistant to ciprofloxacin.24-48

The misuse of first-line antibiotics in the treatment of urinary tract infections (UTIs) has drawn criticism, and recent studies in Africa have found a trend that is consistent with this problem.49 Because E. coli bacteria have demonstrated increased resistance to amoxicillin and amoxiclav, it has been advised to use additional antibiotics when necessary, such as tigecycline and nitrofurantoin.50

Staphylococcal infections caused by MRSA have been linked to increased mortality risks, prolonged hospital stays, and greater healthcare costs. These studies have shown that vancomycin is an effective MRSA therapy. Initially, Streptococcus pneumoniae was the chosen option for treating pneumococcal illness since its antibiotic resistance was relatively low.

However, a recent Asian study has shown contradictory findings. Only three of 140 isolates of Enterococcus spp. were identified to have vancomycin resistance in a specific study (resulting in a 0% resistance rate). It’s important to note that just three studies examined vancomycin susceptibility; hence, in-depth investigation is required to fully comprehend the problem.

This research has revealed significant shortcomings in surveillance methods. The study was conducted in Pabna, where the effectiveness of prescribed antibiotics was limited due to widespread antibiotic resistance resulting from their improper use. This issue affected a substantial portion of the data, with susceptibility results standing at 26.82% and 90.24% for hospital and community infections, respectively.

These discrepancies pose challenges when comparing this study with others of high quality. Further investigation is necessary, particularly for diseases that have been overlooked since there haven’t been enough studies done on them, as is mentioned in the results section, even though ongoing efforts are being made to battle antimicrobial resistance (ABR). The urgent need for appropriate antibiotic usage is highlighted by the lack of novel antibiotics in the market. To protect the effectiveness of current antibiotics, achieving this goal might necessitate the implementation of more stringent antibiotic usage regulations.51

Table 1: Analysis in brief, (n=44).
Table reproduced from source PDF page 3
Table 2: Calculated pathogens’ MR and IQR.
Table reproduced from source PDF page 4, part 1 of 2
Table reproduced from source PDF page 5, part 2 of 2

CONCLUSION

Considering the prevalence of alarming microorganism strains in several hospitals throughout this city, the situation with ABR in Pabna, Bangladesh, is particularly bad. There are significant obstacles to the effectiveness of antibiotics prescribed at Pabna’s hospitals, suggesting possible abuse and overuse of these drugs. ABR currently poses a greater threat to the citizens of Pabna than antibiotic misuse problems do in other cities. Therefore, more research is really necessary in peripheral cities. This work has successfully located antibiotic-resistant bacterial infections in Pabna and emphasized their susceptibility patterns, despite the lack of comprehensive resistance data. Healthcare practitioners can use the information from this study to help them choose an appropriate course of antibiotic medication. Additionally, prescription analysis results imply that tetracycline, amoxicillin, and fourth-generation cephalosporins have evolved resistance in Pabna, providing important information for future research and treatment approach improvements.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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