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  • 1.
    Chowdhury, Moyukh
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Is the seed of Antibiotic Resistance grounded in the community ?: Exploring the societal factors influencing access, use and adherence of antibiotics, facilitating the emergence of antibiotic resistance in a South Asian community.2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
  • 2.
    Chowdhury, Moyukh
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bhattacharyya, Punom Kumar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Antimicrobial resistance in Sylhet, Bangladesh :: A menacing public health challenge2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    BACKGROUND Antimicrobials are a range of powerful medications used in the treatment and preclusion of infections. When micro-organisms stop responding to medicines to which they were formerly susceptible, Antimicrobial resistance (AMR) develops. World Health Organization (WHO) has stated AMR as one of the major public health issues of 21st century. Meanwhile, Comparatively less attention was specified on this burning issue in Bangladesh, a lower middle-income country.

    PURPOSE Aim of the research was to explore the category of organisms evolving resistance, to detect the pattern of resistance of the drug groups in different age, sex and to explore the emergence of Multidrug Resistance (MDR) among patients in the contextual setting of Sylhet, one of the 8 divisional headquarters of the country.

    METHODS A cross-sectional study design by using primary data collected from all the cases referred for culture sensitivity test to 8 major microbiological laboratories of Sylhet for a period of 90 days from 1st January to 31st March 2017. Age, Sex, Isolated pathogens, Specimen type and Spectrum of antimicrobial resistance was taken into consideration for this study. Set of drugs common in all the selected labs were included in the study, namely: Cefixime, Ciprofloxacin, Ceftriaxone, Amoxycillin, Cotrimoxazole, Azithromycin, Gentamicin, Amikacin, Nalidixic acid, Nitrofurantoin and Imipenem. Total number of collected specimen was 555 of 7 different types. Descriptive analysis was conducted and STATA 13 was used for computational statistics.

    RESULTS Most of the specimens were urine samples. Out of total 555 samples, 264 showed microbiological growth. Males (52%) and patients from age group C (age 60≤) were there in terms of number. The majority of the patients were referred from private hospitals (approx. 95%). Gram-negative bacteria’s (198 isolated pathogens) were three times higher than Gram-positive bacteria’s. E.coli as a Gram-negative (46% of total sample) and Streptococcus Pneumonia (approx. 11%) as a Gram-positive bacteria were the most prevalent Pathogens in the study. The emergence of antibiotic resistance in the ground of male-female quantities showed females have comparatively higher resistance in Azithromycin (approx. 57%), Amoxycillin (approx. 69%), Gentamicin (approx. 51%) and Nitrofurantoin (approx. 12%) than males and males dominated in Amikacin (approx. 31%). Most of the cases showed Multidrug resistance (88%), Around 64% observations were resistant to 2 to 5 antibiotics and 24%, 6 and above. The study even explored resistance causing by specific pathogens towards individual drugs where E.Coli showed the highest resistance against each antibiotic.

    CONCLUSION In a country like Bangladesh where most of the health expense is out of pocket, AMR threatens the sustainable development of health conditions by interrupting clinical, psychological and socio-economic aspects in national level. WHO described this issue in “One Health” approach where the health of human, animal and environment complement each other. To combat this public health challenge of emerging antimicrobial resistance, multisectoral strategy should be implemented by policymakers with the development of surveillance system, antibiotic stewardship, raising social awareness and enhancing research before the catastrophe devastates more.

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