Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant : An Emerging Concern to Public Health in Bangladesh.

The emergence of virulent extended spectrum β-lactamase producing (ESBL-KP) including carbapenem-resistant (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common β-lactam resistance gene was (91%), followed by (76.1%), (68.7%), (29.9%), (14.9%), (11.9%), and (4.5%). The carbapenemase genes (55.2%), (28.4%), (14.9%), (13.4%), and (10.4%) and virulence-associated genes such as (71.6%), (58.2%), (56.7%), (47.8%) and (28.4%) were also detected. About 96.2% of the environmental and 100% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections.