Risk Factors for Colonization With Antibiotic-Resistant Bacteria Among Hospitalized Patients in Bangladesh: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Abstract
Background Antibiotic-resistant bacteria (ARB) are frequently linked with healthcare settings, but specific factors associated with colonization within healthcare settings in low- and middle-income countries (LMICs) remain poorly understood. This study explores risk factors for ARB colonization among hospitalized patients in Bangladesh, where 82% were colonized with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE), 37% with carbapenem-resistant Enterobacterales (CRE), and 21% with methicillin-resistant Staphylococcus aureus (MRSA). Methods Hospitalized adults from 3 hospitals in Dhaka completed interviews and underwent chart review to assess healthcare exposures. We used bivariate analyses, random forest variable selection, and multivariate logistic regression to identify factors associated with ESCrE, CRE, and MRSA colonization. Results ESCrE colonization was associated with admission to a non-medical ward (aOR 2.16–8.57, 95% CI 1.14, 64.4) and hospitalization ≥ 3 days before specimen collection (aOR 1.74, 95% CI 1.13, 2.69) while being inversely associated with age (≥45 years, aOR 0.54–0.58, 95% CI .29, .99) and carbapenem use (aOR 0.02, 95% CI < .01, .14). CRE colonization was associated with hospitalization ≥ 3 days before specimen collection (aOR 1.56, 95% CI 1.08, 2.23), third-generation cephalosporin use (aOR 2.93, 95% CI 2.02, 4.23), and other beta-lactam use (aOR 4.83, 95% CI 2.65, 8.81). MRSA colonization was inversely associated with third-generation cephalosporin use (OR 0.60, 95% CI .38, .95). Conclusions Antibiotic use, duration of hospitalization, age, and ward type were associated with ARB colonization among hospitalized patients. Further investigations into antibiotic use patterns and infection prevention and control practices may identify modifiable risk factors to reduce ARB in healthcare settings in LMICs.
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BibTeX
@article{mahemuneer2026risk,
title = {{Risk Factors for Colonization With Antibiotic-Resistant Bacteria Among Hospitalized Patients in Bangladesh: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study}},
author = {Syeda Mah-E-Muneer and Ashley Styczynski and Kamal Hossain and Gemma Parra and Garrett Mahon and Md Zakiul Hassan and Mahmudur Rahman and Gazi Md Salahuddin Mamun and Debashis Sen and Palash Mozumder and Dilruba Ahmed and Aninda Rahman and Amin Ahmed Khan and Moushumi Sarker and Rachel M Smith and Fahmida Chowdhury},
journal = {Open Forum Infectious Diseases},
year = {2026},
month = nov,
doi = {10.1093/ofid/ofag647},
url = {https://doi.org/10.1093/ofid/ofag647},
note = {Public domain},
}
RIS
TY - JOUR
TI - Risk Factors for Colonization With Antibiotic-Resistant Bacteria Among Hospitalized Patients in Bangladesh: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
AU - Syeda Mah-E-Muneer
AU - Ashley Styczynski
AU - Kamal Hossain
AU - Gemma Parra
AU - Garrett Mahon
AU - Md Zakiul Hassan
AU - Mahmudur Rahman
AU - Gazi Md Salahuddin Mamun
AU - Debashis Sen
AU - Palash Mozumder
AU - Dilruba Ahmed
AU - Aninda Rahman
AU - Amin Ahmed Khan
AU - Moushumi Sarker
AU - Rachel M Smith
AU - Fahmida Chowdhury
PY - 2026
DA - 2026/11/02
JO - Open Forum Infectious Diseases
DO - 10.1093/ofid/ofag647
UR - https://doi.org/10.1093/ofid/ofag647
AB - Background Antibiotic-resistant bacteria (ARB) are frequently linked with healthcare settings, but specific factors associated with colonization within healthcare settings in low- and middle-income countries (LMICs) remain poorly understood. This study explores risk factors for ARB colonization among hospitalized patients in Bangladesh, where 82% were colonized with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE), 37% with carbapenem-resistant Enterobacterales (CRE), and 21% with methicillin-resistant Staphylococcus aureus (MRSA). Methods Hospitalized adults from 3 hospitals in Dhaka completed interviews and underwent chart review to assess healthcare exposures. We used bivariate analyses, random forest variable selection, and multivariate logistic regression to identify factors associated with ESCrE, CRE, and MRSA colonization. Results ESCrE colonization was associated with admission to a non-medical ward (aOR 2.16–8.57, 95% CI 1.14, 64.4) and hospitalization ≥ 3 days before specimen collection (aOR 1.74, 95% CI 1.13, 2.69) while being inversely associated with age (≥45 years, aOR 0.54–0.58, 95% CI .29, .99) and carbapenem use (aOR 0.02, 95% CI < .01, .14). CRE colonization was associated with hospitalization ≥ 3 days before specimen collection (aOR 1.56, 95% CI 1.08, 2.23), third-generation cephalosporin use (aOR 2.93, 95% CI 2.02, 4.23), and other beta-lactam use (aOR 4.83, 95% CI 2.65, 8.81). MRSA colonization was inversely associated with third-generation cephalosporin use (OR 0.60, 95% CI .38, .95). Conclusions Antibiotic use, duration of hospitalization, age, and ward type were associated with ARB colonization among hospitalized patients. Further investigations into antibiotic use patterns and infection prevention and control practices may identify modifiable risk factors to reduce ARB in healthcare settings in LMICs.
SN - 2328-8957
ER -