We report an outbreak by MDR K. variicola clone (ST771) in a Bangladeshi neonatal unit from October, 2016 to January, 2017, associated with high mortality (54.5%). During the outbreak, K. variicola ST771 acquired MDR plasmid harbouring blaNDM-1, linked to high exposure to ceftriaxone and amikacin in the NICU of DMCH.

The emergence of mobilized colistin resistance genes (mcr) has become a serious concern in clinical practice, compromising treatment options for life-threatening infections. In this study, colistin-resistant Klebsiella pneumoniae harboring mcr-8.1 was recovered from infected patients in the largest public hospital of Bangladesh, with a prevalence of 0.3% (3/1,097). We found mcr-8.1 in an identical highly stable multidrug-resistant IncFIB(pQil) plasmid of ∼113 kb, which belonged to an epidemiologically successful K. pneumoniae clone, ST15. The resistance mechanism was proven to be horizontally transferable, which incurred a fitness cost to the host. The core genome phylogeny suggested the clonal spread of mcr-8.1 in a Bangladeshi hospital. Core genome single-nucleotide polymorphisms among the mcr-8.1-positive K. pneumoniae isolates ranged from 23 to 110. It has been hypothesized that mcr-8.1 was inserted into IncFIB(pQil) with preexisting resistance loci, blaTEM-1b and blaCTX-M-15, by IS903B. Coincidentally, all resistance determinants in the plasmid [mcr-8.1, ampC, sul2, 1d-APH(6), APH(3′′)-Ib, blaTEM-1b, blaCTX-M-15] were bracketed by IS903B, demonstrating the possibility of intra- and interspecies and intra- and intergenus transposition of entire resistance loci. This is the first report of an mcr-like mechanism from human infections in Bangladesh. However, given the acquisition of mcr-8.1 by a sable conjugative plasmid in a successful high-risk clone of K. pneumoniae ST15, there is a serious risk of dissemination of mcr-8.1 in Bangladesh from 2017 onwards. IMPORTANCE There is a marked paucity in our understanding of the epidemiology of colistin-resistant bacterial pathogens in South Asia. A report by Davies and Walsh (Lancet Infect Dis 18:256–257, https://doi.org/10.1016/S1473-3099(18)30072-0, 2018) suggests the export of colistin from China to India, Vietnam, and South Korea in 2016 was approximately 1,000 tons and mainly used as a poultry feed additive. A few reports forecast that the prevalence of mcr in humans and livestock will increase in South Asia. Given the high prevalence of blaCTX-M-15 and blaNDM in India, Bangladesh, and Pakistan, colistin has become the invariable option for the management of serious infections, leading to the emergence of mcr-like mechanisms in South Asia. Systematic scrutiny of the prevalence and transmission of mcr variants in South Asia is vital to understanding the drivers of mcr genes and to initiate interventions to overcome colistin resistance.

Introduction: Dengue is a major public health concern in our country. The alarming thing is that the seasonal trend of dengue infection is changing with time in Bangladesh due to climate change and unplanned urbanization. Our study was conducted to determine the frequency of dengue virus infection among the febrile patients in 2018 at Dhaka Medical College Hospital (DMCH) and to observe the seasonal trend. Materials and Methods: The study was carried out on 899 febrile patients attended in DMCH from January to December, 2018. Whole blood samples were collected and sera were tested for dengue NS1 antigen and anti-dengue IgM antibodies using commercial test kits (NS1 by OMC Healthcare (Pvt.) Ltd & IgM antibody by Omega Diagnostics Ltd.), respectively. All negative dengue cases were tested for anti Chikungunya antibody to exclude chikungunya. Results: Of the total 899 febrile patients, 350(38.93%) were positive for Dengue infection. Out of them 264(75.43%) were positive for NS1, 82 (23.43%) were positive for IgM and 4 (1.14%) were positive for dengue NS1antigen + anti dengue IgM antibody. More than 50% patients belonged to age group 15-29 years. Males were predominant. More than 60% cases were detected in the post monsoon season. Conclusion: Highest dengue cases were detected in this year in comparison to the previous year’s probably due to re-emergence of DEN-3 serotype. Due to pattern of climate change, seasonal trend of dengue infection was not maintained. Moreover, unplanned urbanization and poor solid waste management have worsened the situation more. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 105-111

Background Given the high prevalence of multidrug resistance (MDR) across South Asian (SA) hospitals, we documented the epidemiology of carbapenem resistant Enterobacterales (CRE) infections at Dhaka Medical College Hospital between October 2016 to September 2017. Methods We enrolled patients and collected epidemiology and outcome data. All Enterobacterales were characterised phenotypically and by whole genome sequencing. Risk assessment for the patients with CRE were performed compared to patients with carbapenem-susceptible Enterobacterales (CSE). Results 10.6% of all 1831 patients with a clinical specimen collected had CRE. In-hospital 30-day mortality was significantly higher with CRE [50/180 (27.8%)] than CSE [42/312 (13.5%)] (p = 0.001); however, for blood-stream infections, this was insignificant. Out of 643 Enterobacterales isolated, 210 were CRE. blaNDM was present in 180 isolates, blaOXA-232 in 26, blaOXA-181 in 24 and blaKPC-2 in 5. Despite this, ceftriaxone was the most commonly prescribed empirical antibiotic and only 27% patients were prescribed at least one antibiotic to which their infecting pathogen was susceptible. Significant risk factors for CRE isolation included burns unit and ICU admission, and prior exposure to levofloxacin, amikacin, clindamycin and meropenem. E. coli ST167 was the dominant CRE clone. Clustering suggested clonal transmission of K. pneumoniae ST15 and the MDR hyper-virulent clone, ST23. The major trajectories involved in horizontal gene transfer were IncFII and IncX3, IS26, and Tn3. Conclusion This is the largest study from a SA public hospital combining outcome, microbiology and genomics. The findings indicate the urgent implementation of targeted diagnostics, appropriate antibiotic use and infection control interventions in SA public institutions.

Introduction: Dengue is now established as one of the most important Arboviral infection in tropical countries. As the epidemic continues worldwide, this Aedes mosquito-transmitted pathogen is considered a major re-emerging tropical disease and significant public health concern. The study was conducted to determine the sero-epidemiology and clinical picture of dengue virus infection among the clinically suspected patients attended in Dhaka Medical College Hospital during January to December 2016.Materials and Methods: The study was carried out on 145 clinically suspected Dengue patients attended in Dhaka Medical College Hospital from January to December 2016 who had fever with temperature >39°C. Blood sample was collected during acute febrile phase of patients and separated sera were tested for NS1 dengue antigen and IgM antibodies using commercial test kits (NS1 by OMC Healthcare (Pvt.) Ltd & IgM antibody by Omega Diagnostics Ltd.).Results: Of the total 145 patients 40 (27.6%) were positive for Dengue NS1 antigen and or IgM antibody test. Of the positive 40 patients, 18 (45%) were positive for NS1, 19 (47.5%) were positive for IgM and 3 (7.5%) were positive for both NS1 and IgM antibody. Major clinical manifestations were fever with arthralgia (79.5%) and retro-orbital pain (50%).Conclusion: Outbreak of Dengue fever is continuing every year and typical presentation of Dengue fever has changed. Arthralgia and retro orbital pain was the most common clinical feature in the present study instead of headache and rash with fever. A large number of suspected dengue cases were negative by Dengue tests for antigen NS1 and IgM antibody which suggests other organisms of similar clinical manifestations are becoming prevalent in Dhaka city.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 111-116