Antibiotic resistance is widespread in Bangladesh, and when it comes to its effect on young children, the suffering becomes deadlier—often resulting in mortality.
A new collaborative study from Massachusetts General Hospital (MGH) with colleagues at the International Centre for Diarrhoeal Disease Research, Bangladesh (known as ICDDRB) revealed antibiotic-resistant Gram-negative bacteremia in young children infected with pneumonia in Bangladesh was associated with a high child mortality rate.
The results of the research are now published in the journal Open Forum Infectious Diseases (Chisti et al., 2021). Experts say the study’s outcome could be an early warning—a pandemic of antibiotic resistance bacterial disease is in foresight and has the potential to spread around the globe.
In the study, Mohammod Jobayer Chisti, MD, PhD, a senior scientist in ICDDRB’s Nutrition and Clinical Services Division, and his colleagues characterized risk factors for pneumonia and death in a cohort of 4007 children admitted to the ICCDRB between 2014 and 2017 with pneumonia.
Pneumonia in Bangladesh, how is it different
Pneumonia is an infection of the lungs. It causes the lung air sacs to fill with fluid and pus, producing cough, fever, and difficulty in breathing. The condition can be fatal, results in death—if not treated adequately.
According to the World Health Organization, pneumonia is the most common cause of death in young children. Viral infection may aggravate pneumonia, but certain bacterial infections are the primary cause of this deadly disease.
In many developed countries, including the USA, Staphylococcus, Streptococcus, and Haemophilus influenzae are the most common bacterial strains that cause pneumonia. When it comes to treatment, these strains respond well to antibiotic therapy. It is noteworthy that the vaccines against the latter two strains have saved many lives worldwide (Wahl et al., 2018).
However, the researchers at MGH, and colleagues at ICCDRB, found a very different pattern of bacterial infection while examining health records of the children under age five admitted to the hospital with pneumonia during the study period.
Among the children, the usual Staphylococcus and Streptococcus infections—the primary cause of pneumonia in The United States—were relatively rare. On the contrary, in 77 percent of the cases, Pseudomonas, E. coli, Salmonella, and Klebsiella were found as the causative strains for pneumonia in the infected children.
“That’s totally different than what I’m used to in my practice in Boston,” says Jason Harris, MD, MPH, chief of Pediatric Global Health at the Massachusetts General Hospital for Children, and co-first author of the paper.
“The Gram-negative bacteria we saw in these kids are notorious for being antibiotic-resistant,” Harris adds, as they found some 40 percent of the Gram-negative bacterial infections resisted treatment with first- and second-line antibiotics routinely used to treat pneumonia. More alarming is the children who had antibiotic-resistant bacterial infections were 17 times more likely than others without bacterial infections to die, the study reports.
Antibiotic resistance, how to stop
To stop the pandemic of antibiotic resistance from killing young children, and stopping the strains from developing resistance to antibiotics, the researchers have made several recommendations.
It is urgent that we address the causes promoting antibiotic resistance in Bangladesh, mentioned Tahmeed Ahmed, PhD, executive director of ICDDRB and senior author of the study.
Using antibiotics without prescription in Bangladesh is very common. People consume the drugs to self-treat conditions like common cold, cough, fever, and dysentery. Misuse of antibiotics could cause the bacteria to develop resistance and promote its spread—experts believe.
“We may be able to reduce this emerging bacterial resistance by improving antibiotic stewardship, particularly in the outpatient setting,” says Ahmed.
A proper diagnosis is paramount to stopping the spread of any infectious disease. However, for the identification of bacterial infections, laboratory testing facility is limited in the country. “What’s more, lack of access to clean water and adequate sanitation helps spread bacteria that are resistant to antibiotics,” says Ahmed.
He argues that improvements in the health care system and policy changes to control the misuse of antibiotics are essential. However, Ahmed notes that Bangladesh’s health care unit needs adequate access to more advanced antibiotic therapies against resistant infections.
If the recommendations aren’t addressed now, the antibiotic resistance disease likely spreads worldwide shortly, cautions Harris, in a statement. “We know that acquisition of antibiotic resistance is very common in travelers and that when highly resistant bacteria crop up in one part of the world, they ultimately crop up everywhere,” he pointed out, refereeing the problem COVID-19, the current global health care crisis world community is facing.
“If COVID-19 was a tsunami, then emerging antibiotic resistance is like rising floodwater. And it’s kids in Bangladesh who are already going under.”
Chisti, M. J., J. B. Harris, et al. (2021). “Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate.” Open Forum Infectious Diseases 8(7). 10.1093/ofid/ofab260.
Wahl, B., K. L. O’Brien, et al. (2018). “Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15.” Lancet Glob Health 6(7): e744-e757. 10.1016/S2214-109X(18)30247-X.