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New research · Pulmonology & Critical Care
Microbiology spectrum · 16h
Cohort studyMicrobiology spectrum · 2026

Difficult-to-treat resistant Gram-negative bacteria and genomic resemblances between colonization and infection among patients in an intensive care unit of a tertiary care hospital in Bangladesh.

Gazi Md Salahuddin Mamun, Md Shahinur Rahaman, Sanzida Khan … Fahmida Chowdhury
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Pulmonology & Critical CareCohort study

ICU colonization with difficult-to-treat-resistant Gram-negative bacteria linked to more subsequent infections

Difficult-to-treat resistant Gram-negative bacteria and genomic resemblances between colonization and infection among patients in an intensive care unit of a tertiary care hospital in Bangladesh.

Gazi Md Salahuddin Mamun et al. · Microbiology spectrum · 2026
Background

Colonization with difficult-to-treat-resistant Gram-negative bacteria (DTR-GNB) increases the risk of subsequent infections with limited treatment options.

Purpose

This study aimed to assess the burden of DTR-GNB colonization in ICU patients, explore its association with clinical outcomes, and examine genomic similarities.

Methods

This secondary analysis included patients enrolled within 24 h of ICU admission between July 2023 and January 2024.

n = 373 patients
Results

Colonized patients had about 2-fold higher risk of later infection than non-colonized

RR 1.57 (95% CI 1.34 to 1.84)
null = 11.341.84
CI excludes the null - significant
More results

Among 373 patients, 181 (48.5%) were colonized with DTR-GNB; 76 (20.4%) at enrollment, and 105 (53.0%) acquired during hospital stay.

DTR-GNB-infected patients had a higher risk of death (RR: 1.57, 95% CI: 1.34-1.84) compared to patients without DTR-GNB infection.

More results

WGS revealed that 13 of 14 paired colonization-infection isolates were conspecific, with three pairs being highly clonal; whereas the remaining pairs showed greater genomic divergence, consistent with the SNP and phylogenetic analyses.

Alarmingly, more than 90% of patients infected with DTR-GNB expired in the hospital.

“
Conclusion

Addressing this emerging resistance phenotype is critical to improving patient safety and reducing the burden on healthcare systems.

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