Prevalence of Colonization With Antibiotic-Resistant Organisms in Hospitalized and Community Individuals in Bangladesh, a Phenotypic Analysis: Findings From the Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Abstract Background Low- and middle-income countries bear a disproportionate burden of antimicrobial resistance (AMR) but often lack adequate surveillance to inform mitigation efforts. Colonization can be a useful metric to understand AMR burden. We assessed the colonization prevalence of Enterobacterales with resistance to extended-spectrum cephalosporins, carbapenems, colistin, and methicillin-resistant Staphylococcus aureus among hospital and community dwellers. Methods Between April and October 2019, we conducted a period prevalence study in Dhaka, Bangladesh. We collected stool and nasal specimens from adults in 3 hospitals and from community dwellers within the hospitals’ catchment area. Specimens were plated on selective agar plates. Isolates underwent identification and antibiotic susceptibility testing using Vitek 2. We performed descriptive analysis and determined population prevalence estimates accounting for clustering at the community level. Results The majority of both community and hospital participants were colonized with Enterobacterales with resistance to extended-spectrum cephalosporins (78%; 95% confidence interval [95% CI], 73–83; and 82%; 95% CI, 79–85, respectively). Thirty-seven percent (95% CI, 34–41) of hospitalized patients were colonized with carbapenems compared with 9% (95% CI, 6–13) of community individuals. Colistin colonization prevalence was 11% (95% CI, 8–14) in the community versus 7% (95% CI, 6–10) in the hospital. Methicillin-resistant Staphylococcus aureus colonization was similar in both community and hospital participants (22%; 95% CI, 19–26 vs 21% (95% CI, 18–24). Conclusions The high burden of AMR colonization observed among hospital and community participants may increase the risk for developing AMR infections and facilitating spread of AMR in both the community and hospital. Colonization with extended-spectrum cephalosporin-resistant Enterobacterales was found among the majority of community and hospital participants in Dhaka, Bangladesh. Colonization prevalence with methicillin-resistant Staphylococcus aureus and colistin-resistant Enterobacterales was similar between community and hospital participants. Carbapenem-resistant Enterobacterales was detected more frequently among hospital participants, but a substantial number of community participants were also colonized with carbapenem-resistant Enterobacterales.