A recent study published in PLOS Global Public Health has highlighted a serious public health concern in southern Bangladesh: 30.56% of culture-positive Urinary Tract Infection cases were found to be multidrug-resistant. In simple terms, almost one in three confirmed UTI cases in the analysed samples showed resistance to multiple antibiotics, making treatment more difficult and increasing the risk of treatment failure.

The research paper, titled “Determinants of multidrug-resistant urinary tract infections: A retrospective cross-sectional study from a tertiary care hospital in southern Bangladesh,” was authored by Ibrahim Khalil, Abu Sayed, A. K. M. Akbar Kabir, Md. Nurul Alam, S. M. Iqbal Hossain, Rahima Akther Dipa, and Md Tanvir Rahman.

The study was conducted at Sher-E-Bangla Medical College & Hospital in Barishal, Bangladesh, using urine culture and antimicrobial susceptibility testing data collected between January and December 2023. The aim of the research was to identify important predictors and risk factors associated with multidrug-resistant urinary tract infections in a tertiary healthcare setting.

Urinary tract infections are among the most common bacterial infections worldwide. Although many UTIs can be treated successfully with antibiotics, the increasing spread of multidrug-resistant bacteria is making treatment more difficult, especially in low-resource settings. Multidrug resistance means that bacteria are resistant to at least one antimicrobial drug from three or more antibiotic classes. This creates a serious public health concern because it can lead to treatment failure, longer illness, repeated hospital visits, increased healthcare costs, and higher risk of complications.

The study analysed urine culture and antimicrobial susceptibility testing data from patients suspected of having UTIs. Out of the culture-positive samples included in the final analysis, almost one-third were found to be multidrug-resistant. This finding shows that antibiotic resistance is not a distant threat; it is already affecting routine clinical infections in Bangladesh.

The most common bacterial isolate was Escherichia coli, which is widely known as the leading cause of UTIs. Other important organisms included Pseudomonas spp., Klebsiella spp., and Acinetobacter spp. Although E. coli was the most frequently detected pathogen, the study found that resistance patterns varied by bacterial species, highlighting the need for laboratory-based diagnosis rather than blind or repeated antibiotic use.

One of the major findings was that male patients had a higher risk of MDR-UTIs compared with female patients. While females had a higher overall number of UTI cases, MDR status was more strongly associated with males. This may be linked to the clinical complexity of male UTIs, including possible urinary tract abnormalities, catheter use, prostate-related conditions, hospitalization, and greater exposure to broad-spectrum antibiotics.

The study also found that samples from specialized hospital units and private medical settings were more likely to be associated with MDR compared with outpatient department samples. This indicates that healthcare exposure, institutional antibiotic practices, infection control measures, and patient treatment history may play an important role in the development and spread of resistant infections.

A particularly important result was the significantly higher MDR risk among male patients from private medical settings. This suggests that antibiotic prescribing practices, follow-up systems, diagnostic testing access, and stewardship activities in different healthcare settings need closer attention.

The findings support the urgent need for stronger antimicrobial stewardship in Bangladesh. Antibiotics should be prescribed based on clinical need and, whenever possible, supported by culture and sensitivity testing. Hospitals, private clinics, laboratories, and community pharmacies all have a role to play in preventing unnecessary antibiotic use and reducing the spread of resistant bacteria.

From a One Health perspective, antimicrobial resistance is not only a hospital issue. Resistant bacteria can move between humans, animals, food systems, water, and the environment. Therefore, controlling MDR-UTIs requires coordinated action across human health, veterinary health, environmental health, public education, and policy sectors.

For Bangladesh, the study provides valuable local evidence from the south-western region, where context-specific AMR data have been limited. It also shows the importance of continuous surveillance, improved laboratory capacity, public awareness, infection prevention, and evidence-based antibiotic use.

OHYAB believes this study is a timely reminder that young professionals, students, healthcare workers, veterinarians, researchers, policymakers, and communities must work together to protect the effectiveness of antibiotics. Responsible antibiotic use today is essential for safer treatment tomorrow.

Key Takeaway:
Multidrug-resistant UTIs are a growing public health concern in Bangladesh. Better antibiotic stewardship, stronger surveillance, infection control, culture-based treatment, and One Health collaboration are urgently needed to reduce the burden of resistant infections.

Community Message 

• Do not take antibiotics without a registered doctor’s advice.

• Do not buy antibiotics directly from pharmacies for urinary symptoms without proper consultation.

• Complete the full antibiotic course if a doctor prescribes it.

• Do not stop antibiotics early just because symptoms improve.

• Do not share leftover antibiotics with family members, friends, or neighbours.

• Do not reuse old prescriptions for new infections.

• If UTI symptoms continue or return, ask a doctor about urine culture and sensitivity testing.

• Common UTI symptoms include burning urination, frequent urination, lower abdominal pain, fever, cloudy urine, or blood in urine.

• Men, elderly people, hospitalized patients, catheter users, and people with repeated infections should seek medical care early.

• Drink safe water and maintain proper personal hygiene.

• Hospitals and clinics should strengthen hand hygiene, disinfection, catheter care, and infection control.

• Doctors and health workers should prescribe antibiotics based on evidence and local resistance patterns.

• Laboratories should support timely culture and sensitivity testing.

• Communities should understand that antibiotic resistance can spread through people, animals, food, water, and the environment.

• Responsible antibiotic use is a One Health responsibility.

• Protect antibiotics today so they can continue saving lives tomorrow.

Press by: Abu Sayed

Contact for the Press: mail@ohyab.org