Antibiotic use and resistance in the food and agricultural sectors in Bangladesh : present risk factors and possible improvements

Sammanfattning: Antimicrobial resistance (AMR) is one of the biggest threats against public health in the world. Antimicrobial substances are used within all different sectors and contribute to development of AMR. Global action against irresponsible use of antibiotics and further development of AMR has been of great concern in the last years and risk factors are being pointed out. Low- and middle-income countries (LMICs) have a precarious role in the matter. Insufficient health care systems, poor law enforcement and, high accessibility of over-the-counter drugs (OTCs) are contributing to the unregulated use of antibiotics. Poorly developed surveillance programmes make it hard to correctly analyse the situation of both antimicrobial use (AMU) and AMR. Bangladesh, like its neighbouring countries, faces a lot of challenges regarding public health. One of the major concerns related to public health is access to safe food. Food products can be contaminated with toxins, chemical substances, and microbial organisms, including AMR-bacteria. Furthermore, national programmes for surveillance of AMU and AMR are inadequate. In this study, data from previously done field studies by Bangladesh Livestock Research Institute (BLRI), Bangladesh Food Safety Authority (BFSA), International Livestock Research Institute (ILRI), and International Food Policy Research Institute (IFPRI) and newly collected information from interviews were put together to analyse the AMR situation in Bangladesh. Sampling of food products (tomato, chicken, fish) from traditional markets and supermarkets was done at three locations representing rural, peri-urban, and urban areas from November 2018 to June 2019. Samples were tested for prevalence of Salmonella spp, Escherichia coli, Vibrio cholerae. Samples positive for bacteria were tested for antimicrobial susceptibility through disc diffusion test. As a supplement to the analysis of samples, questionnaires to the vendors of the food products were made to provide background information. During 2020, statistical analysis of previously collected data and interviews with stakeholders working with AMR was made. The interviews aimed to serve as baseline information about current conditions regarding AMU and AMR. 320 cultivations of 1589 (20.1%) were positive for bacterial prevalence. 319 of these were tested for antimicrobial susceptibility where 203 (63.6%) were found to be multidrug-resistant (MDR) (resistant to three or more antibiotic groups). Furthermore, interviews with stakeholders stated that surveillance of AMU and AMR in Bangladesh is inadequate, especially within the animal and agriculture sector, and that a one health approach on a government level is needed to improve the situation. To be able to fully analyse the AMR situation in Bangladesh, a nation-wide study would need to be conducted, within all sectors, including both AMU and AMR testing.