Deadly superbugs sweep Dhaka ICU
Studies find extremely high mortality among infected patients, while stronger infection-control measures sharply reduce infections and deaths More than half of critically ill patients who were initially free of difficult-to-treat drug-resistant bacteria acquired them during their stay in a Dhaka hospital’s intensive care unit, according to two new studies by icddr,b.
Published in Microbiology Spectrum and Antimicrobial Resistance & Infection Control, the studies also found high mortality among infected patients. However, they showed that stronger infection prevention and control measures could substantially reduce bloodstream infections and deaths.
The researchers analysed data from 373 critically ill adults admitted to the ICU of a tertiary government hospital in Dhaka between July 2023 and February 2024. They also studied 363 newborns admitted to the hospital’s neonatal intensive care unit between December 2023 and September 2024.
More than half acquire bacteria in ICU
The ICU study, funded by the US Centers for Disease Control and Prevention, focused on difficult-to-treat resistant Gram-negative bacteria that can cause pneumonia, bloodstream infections, urinary tract infections and wound infections.
Researchers examined four major hospital-associated pathogens: Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa.
Nearly half, or 48.5%, of the ICU patients were already colonised with the bacteria in their gut when admitted.
Although colonisation does not necessarily cause illness, it increases the risk of infection and transmission within healthcare facilities.
Among 198 patients initially free of the bacteria, 105, or 53%, acquired them during their ICU stay, indicating substantial transmission inside the hospital.
Using laboratory testing and whole-genome sequencing, researchers found that, in some patients, the same bacterial strain identified during colonisation later caused life-threatening infections.
Mortality exceeded 90% among patients with culture-confirmed infections.
The researchers said the exceptionally high death rate likely reflected overcrowded ICUs, resource constraints, limited treatment options and hospital-acquired infections.
“We followed ICU patients throughout their stay and used laboratory testing and whole-genome sequencing to understand how resistant bacteria spread within the hospital and how colonisation later progressed to infection,” said Gazi Md Salahuddin Mamun, an assistant scientist at icddr,b and lead author of the study.
Fahmida Chowdhury, head of icddr,b’s antimicrobial resistance research unit and principal investigator of the study, said hospitals should be places of healing rather than settings where patients acquire life-threatening infections.
She said the findings underlined the need for stronger hospital hygiene, infection prevention and responsible antibiotic use.
NICU programme cuts infections and deaths
The second study evaluated an infection prevention and control programme in a Dhaka neonatal ICU.
Healthcare workers and cleaning staff received initial and monthly training on hand hygiene, environmental cleaning, waste management and infection prevention.
Researchers also monitored compliance, bloodstream infections, mortality and colonisation with carbapenem-resistant organisms.
After seven months, bloodstream infections fell from 28 to four per 100 admissions-an 86% reduction.
Mortality also declined from 26 to four deaths per 100 admissions.
The findings showed that stronger infection-control measures could prevent severe infections and deaths even where resistant bacteria were widespread.
icddr,b Executive Director Tahmeed Ahmed said the studies demonstrated that patients were acquiring difficult-to-treat bacteria while receiving hospital care, but improved infection prevention, surveillance, hygiene and responsible antibiotic use could significantly reduce the risks.
He urged hospital authorities and policymakers to treat such measures as core patient-safety priorities in the fight against antimicrobial resistance.
