The Reign of Superbugs in Bangladesh’s ICUs and NICUs: A Silent Pandemic

Antimicrobial Resistance (AMR) stands as one of the greatest threats to human health and the progress of modern medicine today. According to the World Health Organization (WHO), it ranks among the top 10 global public health threats, pushing healthcare systems towards growing uncertainty. Recent global statistics indicate that between 2020 and 2021, approximately 1.2 million people died annually as a direct result of drug-resistant pathogens, while the indirect death toll reached nearly 4.8 million. Experts warn that without effective preventive measures at both global and national levels, AMR could claim 10 million lives annually by 2050. This means that roughly every three minutes, someone could die from a common infection that cannot be treated with any currently available medication.

Alarming reality in Dhaka’s leading hospitals

Compared with the developed world, the situation in Bangladesh is far more complex, uncontrolled, and alarming. Major hospitals across the country—specifically their intensive care units (ICUs) and neonatal intensive care units (NICUs)—have increasingly become settings with a rising prevalence of resistant organisms. To gain a deeper understanding of this crisis, we visited several leading medical institutions in Dhaka, including the National Institute of Cardiovascular Diseases (NICVD), Dhaka Medical College Hospital (DMCH), Bangladesh Medical University (BMU), Universal Medical College Hospital, United Medical College Hospital, and the Bangladesh Shishu Hospital and Institute. Dr Kakoli Halder, an assistant professor in the Department of Microbiology at Dhaka Medical College, reiterates that AMR is a silent epidemic. Our research reveals that approximately 80% of newborns admitted to the NICU carry antibiotic-resistant organisms, and 60% of these infants contract new healthcare-associated infections (HAIs) from the hospital environment itself. At the root of this crisis lie the irrational use of antibiotics and the widespread failure to complete prescribed courses of medication.

Ineffective first-line antibiotics endangering newborns

The NICU represents one of the most sensitive and critical areas of Bangladesh's healthcare system. However, these units are facing immense clinical pressure as infants suffering from neonatal sepsis—bloodstream infections in newborns—frequently encounter multidrug-resistant strains. In accordance with WHO standards and national guidelines, the combination of Ampicillin and Gentamicin has long served as the standard first-line treatment for serious neonatal infections. However, recent field studies reveal that this traditional, reliable treatment regimen has seen its clinical efficacy drastically diminished in the country, failing to yield expected therapeutic outcomes in a vast majority of cases.

Grim findings of the Global BARNARDS II study

Data from the BARNARDS II study—conducted under the scientific supervision of Oxford University and through international collaboration—has exposed the magnitude of this crisis. This international study monitored approximately 14,000 infants treated across 13 leading neonatal units in Bangladesh, Pakistan, and Nigeria between 2024 and 2025. The findings, presented at the ESCMID Global 2026 conference, show that the standard Ampicillin and Gentamicin combination is now effective in only 25% of cases due to high bacterial resistance. Put simply, this primary life-saving regimen fails to work for three out of every four infants suffering from sepsis. Among 2,821 cases with complete microbiological data, only 36.8% of the newborns received appropriate empirical treatment, resulting in significantly higher mortality rates among the remaining infants. Because many peripheral hospitals lack adequate laboratory and culture facilities, doctors face a blind gamble, unable to determine immediately for which infants the primary medication will fail.

High cost and toxicity of reserve-group drugs

With culture-sensitivity reports revealing up to 80% resistance to widely used drugs like Ampicillin, Amoxicillin, and Cefepime, physicians are compelled to administer "reserve-group" antibiotics—high-potency drugs of last resort, such as Meropenem or Colistin—at the very onset of sepsis. While these reserve antibiotics are highly appropriate and lifesaving when clinically indicated by documented resistance patterns, they must ideally be utilised within strict antimicrobial stewardship frameworks to prevent the rapid development of resistance against these final lines of defence. In developed nations, clinicians would not consider using these drugs without a prior culture report. These potent medications are not only prohibitively expensive for average families but can also cause severe toxicity in the delicate, tiny bodies of newborns. Furthermore, there is a severe shortage of child-friendly paediatric formulations in Bangladesh. When high-potency tablets or injections intended for adults are split based on rough estimates, the high risk of dosing errors can potentially cause serious damage to a newborn's fragile liver and kidneys.

Integrated roadmap and national strategy for survival

To avert this looming catastrophe, we cannot simply rely on the development of new antibiotics. A comprehensive national strategy requires an upgraded roadmap that places equal and aggressive emphasis on institutional antimicrobial stewardship, expanded diagnostic capacity at the grassroots level, equitable access to quality-assured medicines, and continuous epidemiological surveillance. Dr Azharul Islam Khan, a member of Bangladesh’s Health Sector Reform Commission, emphasises that addressing this crisis requires establishing blood culture facilities at the district level and strictly enforcing Infection Prevention and Control (IPC) protocols in hospitals. Dr Sanjida Khondakar Setu notes that by implementing simple IPC interventions, such as proper handwashing and environmental cleanliness, healthcare facilities can significantly reduce bloodstream infection rates. Additionally, the sale of over-the-counter antibiotics without prescriptions must be halted, and a "One Health" policy must be implemented to regulate antibiotic use in agriculture. Finally, national vaccination programmes, such as rotavirus vaccination for children, must be strengthened to prevent diarrhoeal diseases and directly reduce the unnecessary demand for antibiotics.

If the nation fails to confront this silent pandemic immediately, minor, common infections will become fatal for future generations. Within the context of Bangladesh, mitigating neonatal mortality and achieving the Sustainable Development Goals depends to a great extent on preventing sepsis and controlling AMR. A unified approach across medicine, industry, and policy is the only way to safeguard future generations.

The write-up is a part of Without Borders Media Fellowship by MSF-GARDP Grant on Antimicrobial Resistance, which encourages independent, impartial, and neutral reporting on health and humanitarian crises. 

The writer is an MPhil researcher at the University of Dhaka. He can be reached at [email protected]