Risk Factors for Colonization With Antibiotic-Resistant Bacteria Among Hospitalized Patients in Bangladesh: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Syeda Mah-E-Muneer, Ashley Styczynski, Kamal Hossain, Gemma Parra, Garrett Mahon, Md Zakiul Hassan, Mahmudur Rahman, Gazi Md Salahuddin Mamun, Debashis Sen, Palash Mozumder, Dilruba Ahmed, Aninda Rahman, Amin Ahmed Khan, Moushumi Sarker, Rachel M Smith, Fahmida ChowdhuryAbstract
Background
Antibiotic-resistant bacteria (ARB) are frequently linked with healthcare settings, but specific factors associated with colonization within healthcare settings in low- and middle-income countries (LMICs) remain poorly understood. This study explores risk factors for ARB colonization among hospitalized patients in Bangladesh, where 82% were colonized with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE), 37% with carbapenem-resistant Enterobacterales (CRE), and 21% with methicillin-resistant Staphylococcus aureus (MRSA).
Methods
Hospitalized adults from 3 hospitals in Dhaka completed interviews and underwent chart review to assess healthcare exposures. We used bivariate analyses, random forest variable selection, and multivariate logistic regression to identify factors associated with ESCrE, CRE, and MRSA colonization.
Results
ESCrE colonization was associated with admission to a non-medical ward (aOR 2.16–8.57, 95% CI 1.14, 64.4) and hospitalization ≥ 3 days before specimen collection (aOR 1.74, 95% CI 1.13, 2.69) while being inversely associated with age (≥45 years, aOR 0.54–0.58, 95% CI .29, .99) and carbapenem use (aOR 0.02, 95% CI < .01, .14). CRE colonization was associated with hospitalization ≥ 3 days before specimen collection (aOR 1.56, 95% CI 1.08, 2.23), third-generation cephalosporin use (aOR 2.93, 95% CI 2.02, 4.23), and other beta-lactam use (aOR 4.83, 95% CI 2.65, 8.81). MRSA colonization was inversely associated with third-generation cephalosporin use (OR 0.60, 95% CI .38, .95).
Conclusions
Antibiotic use, duration of hospitalization, age, and ward type were associated with ARB colonization among hospitalized patients. Further investigations into antibiotic use patterns and infection prevention and control practices may identify modifiable risk factors to reduce ARB in healthcare settings in LMICs.