シンポジウム 154）Combating antimicrobial resistance:Antibiotic surveillance program in Bangladesh

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh○Ruhul Amin Miah
Emergence of antimicrobial resistance is becoming a major public health problem in our country. Multi drug resistantorganisms like E.coli, Klebsiella, Pseudomonas and Acinetobacter species have given new dimensions to the problem of
hospital-associated infections. A relatively high prevalence rate of ESBL producers have been documented, varying from34.56 to 83.61%. Major ESBL producing organisms are E.coli, Klebsiella pneumoniae, Proteus, Pseudomonas andAcinetobacter spp. The prevalence of MBL producer is 43 to 81.4% among MDR Pseudomonas and 63.2% for total
Acinetobacter isolates. Resistance to first-line anti-TB drugs has become a concern for national TB control programme.
MDR-TB was found 1.4% among new cases and 28.5% among previously treated cases and XDR-TB was found in only in
05 cases. Data revealed an increasing trend of development of resistance to commonly used antimicrobials in pathogens like
Salmonella, Shigella, V.cholerae, Staph aureus, Neisseria spp, Klebsiella, Mycobacterium tuberculosis.
At present there is no population level database on the use of antimicrobial agents. Most of the antimicrobials are available
over the counter all over the country and usually prescribed even by unqualified or unauthorized personnel. So far, noprescription records are kept at pharmacy or private sectors. For surveillance of antimicrobial resistance, government isplanning to establish a national network of laboratories to be coordinated by a National Reference Laboratory. Plans also
include national policy on antimicrobial resistance, national monitoring system on antibiotic use pattern, updating essential
drugs, and their rational use at all levels of healthcare facilities, monitoring pharmacy, their sale practice and collaboration
among with other countries.
In some institute there is antibiotic guideline for empirical and standard treatment for common infectious diseases of publichealth concern which are in process of updating. Though a large number of laboratories in the country are carrying out drug
susceptibility testing of micro organisms, the data is either not analyzed on a regular basis or not being disseminated for useof clinicians and there is inadequacy of quality assured laboratories. Training programs, seminars, workshops or symposium
on rational use of drugs and infection control are being organized for health care professionals including undergrad students.
Basic researches in different institutes are being conducted with emphasis on microbial pathogenesis, drug resistancepattern, methods of spread and national impact.
Antimicrobial resistance combat is a big challenge for us that need to be addressed for effective containment of thisemerging issue. There is a strong need to formulate treatment guideline and an effective surveillance system to generatereliable information regarding baseline data, trends of antimicrobial resistance, rational use of antimicrobials and thenational impact of drug resistance. Development of national antibiotic policy, strict Pharmacy law and infection control
guideline and to ensure their applicability in all aspect of health sectors is a national priority for Bangladesh to combat drug
resistance.