Patterns of Antimicrobial Resistance Among Major Bacterial Pathogens Isolated from Clinical Samples in Bangladesh (2017–2020): A Nationwide Cross-Sectional Study

Antimicrobial resistance (AMR) is a critical public health issue in Bangladesh, where antibiotic use is widespread but often unregulated. A nationwide study (2017–2020) analyzing data from 26 laboratories examined bacterial resistance trends across 232,329 isolates from various clinical specimens. Escherichia coli was the most common pathogen (32.48%), followed by Klebsiella spp. (15.50%) and Pseudomonas spp. (10.60%). Urine specimens comprised 50.3% of tested samples, while blood and soft tissue/body fluids accounted for 12.1% and 24.8%, respectively. Patients aged 55+ years represented the largest proportion (36.3%), highlighting their vulnerability to drug-resistant infections. Resistance to third-generation cephalosporins was alarmingly high in E. coli (62.89% resistant to ceftriaxone), whereas resistance to carbapenems remained relatively low (imipenem 5.31%, meropenem 6.81%). Klebsiella spp. exhibited widespread resistance, though carbapenems remained effective. In contrast, Salmonella spp. remained sensitive to third-generation cephalosporins. However, 42% of Staphylococcus aureus isolates were methicillin-resistant (MRSA). This study highlights the urgent need for improved antibiotic stewardship, enhanced diagnostic capacity, and strengthened AMR surveillance to mitigate resistance trends and preserve treatment options in Bangladesh. Immediate action is necessary to combat the growing threat of multidrug-resistant pathogens.