The Silent Killer Threatening Children

Antimicrobial Resistance (AMR) and neonatal health crises have escalated into critical public health emergencies across Bangladesh, threatening national healthcare infrastructure and standard of living. Driven by the unregulated use of antibiotics, severe diagnostic bottlenecks, poor hospital hygiene, and environmental contamination, multidrug-resistant superbugs are now primary contributors to rising child mortality. 

Evaluating sepsis risk scores in paediatric care

Paediatric sepsis remains a leading cause of child mortality across Bangladesh. A separate observational study focused on children admitted with active sepsis to a tertiary hospital in Dhaka revealed an in-hospital mortality rate of approximately 23%. Although this research focused on older paediatric cohorts (aged two months to 18 years), evaluating international organ dysfunction scoring systems like PELOD-2, pSOFA, and the Phoenix Sepsis Score provides vital insights into optimising early critical care management, which can systematically inform and strengthen risk stratification frameworks for vulnerable newborns. The results demonstrated that all three scoring methods had high predictive accuracy. Among them, pSOFA and PELOD-2 provided the most precise discrimination of mortality risk, yielding Area Under the Curve (AUC) values of 0.83 and 0.82, respectively. 

Escalating institutional risks and environmental pollution

AMR in Bangladesh has evolved from a health risk into a dire crisis. Prof Abu Naser Ibne Sattar, chairman of the Department of Microbiology and Immunology at Bangladesh Medical University (BMU), characterises the trend as a total "treatment failure." Multidrug-resistant infections are now a primary cause of child mortality in the country. Prof Sattar's research indicates that poor hospital waste management and environmental pollution are accelerating the spread of these superbugs, as antibiotic residues present in hospital waste can also make beneficial environmental bacteria resistant.

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The Reign of Superbugs in Bangladesh’s ICUs and NICUs: A Silent Pandemic

Invisible pathogens colonising hospital infrastructure

Sanjida Khondakar Setu, an associate professor in the Department of Microbiology and Immunology at BMU, highlights that hospital-acquired infections pose a major challenge. Investigators have detected potent pathogens, such as carbapenem-resistant Klebsiella pneumoniae and Acinetobacter, on high-touch surfaces, patient bed rails, neonatal cots, weighing scales, and hospital air-conditioning condensate. Within just 48 hours of admission, patients can contract new infections from these aggressive, mutated pathogens. Approximately 80% of patients admitted to intensive care units (ICUs) and neonatal intensive care units (NICUs) carry various types of resistant pathogens, and within 14 to 21 days of hospitalisation, virtually all patients become colonised or infected, exponentially increasing medical costs and mortality risks.

Rapid mutation of dangerous community strains

Fahmida Chowdhury, associate scientist and lead of the AMR Research Unit at icddr,b, notes that AMR is making conventional medical treatments completely ineffective. Genome sequencing of approximately 3,000 antibiotic-resistant bacteria at the icddr,b laboratory has revealed that pathogens such as E coli and Klebsiella are rapidly evolving into highly potent strains. Alarmingly, resistant strains of E coli are being detected in approximately 80% of even the healthy population, posing a serious threat to the wider community.

Diagnostic bottlenecks and laboratory capacity reform

A primary obstacle to successfully treating neonatal sepsis in Bangladesh is the severe shortage of diagnostic infrastructure. Most district-level healthcare facilities lack the laboratory capacity required to perform reliable blood cultures or culture-sensitivity testing. Consequently, physicians are routinely forced to initiate high-dose, broad-spectrum antibiotic treatment based solely on clinical assessment. This practice, known as empirical therapy, frequently exacerbates the development of antibiotic resistance.

Expanding access to advanced, rapid diagnostics is critical, as improved diagnostic capacity enables clinicians to transition from empirical bludgeoning to targeted narrow-spectrum therapy. This shift directly promotes better clinical stewardship, reduces the unnecessary use of last-line antibiotics, and improves patient survival rates. 

Azharul Islam Khan, a member of the Health Sector Reform Commission of the interim government, emphasises that structural policy reform within the national healthcare ecosystem is now essential to counter AMR. The lack of advanced diagnostic facilities and blood culture systems across district hospitals leaves physicians with little choice but to rely on empirical, high-dose antibiotic treatments. This inevitably drives up resistance rates.

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Blueprint to Combat Neonatal Sepsis and AMR in Bangladesh

Pharmaceutical innovation and strategic public-private partnerships

Resolving this crisis demands extensive public awareness and coordinated action across sectors. Society must move away from the practice of using antibiotics to treat common viral illnesses such as colds, coughs, or flu strains. Patients must take antibiotics exactly as prescribed and complete the recommended course. Prof Sardar A Nayeem, chairman of Navana Pharmaceuticals PLC, highlights the pharmaceutical manufacturing sector’s profound responsibility in addressing this global AMR crisis.

Currently, Bangladesh faces an acute shortage of child-friendly, dedicated paediatric formulations for newborns. Frequently, clinicians are forced to adapt highly potent adult-dosage antibiotics for infants. This creates significant dosing challenges and heightens the risk of toxic side effects. It is deeply alarming that WHO-approved first-line antibiotics remain effective in only 25% of local cases. However, pharmaceutical innovation must extend beyond merely developing novel drug combinations; it must encompass ensuring equitable access to quality-assured, affordable antibiotics and generating robust local evidence on their efficacy. Through strategic public-private partnerships, the country can help ensure the availability of appropriate medicines and avert this catastrophic threat.

The write-up is a part of Without Borders Media Fellowship by MSF-GARDP Grant on Antimicrobial Resistance, which encourages independent, impartial, and neutral reporting on health and humanitarian crises. 

The writer is an MPhil researcher at the University of Dhaka. He can be reached at [email protected]