Background: To aid in the development of antimicrobial stewardship programs (ASPs), we analyzed the patterns and trends in antibiotic prescriptions for patients with severe acute respiratory infection (SARI), utilizing the WHO’s AWaRe classification. Methods: We analyzed data from hospital-based influenza surveillance from January 2011 to December 2020 across nine Bangladeshi tertiary-level hospitals. Surveillance physicians collected WHO-defined SARI patient data, including demographics, clinical characteristics, and antibiotic prescriptions. Descriptive statistics and parametric and non-parametric tests were used for the analysis. Results: Of 21,566 SARI patients [median age 20 years (IQR: 1.33–45), 66% male], 91% were prescribed at least one antibiotic. A total of 25,133 antibiotics were prescribed, of which 47.0% were third-generation cephalosporins, 16.5% were macrolides, and 11.1% were beta-lactam/beta-lactamase inhibitors. According to the AWaRe classification, 28.7% were in the Access group, while 71.3% were in the Watch group, and none were from the Reserve group. A downward trend in Access group (30.4% to 25.1%; p = 0.010) and an upward trend in Watch group antibiotic prescription (69.6% to 74.9%; p = 0.010) were observed. We identified that patients aged < 5 years (aOR: 1.80; 95% CI: 1.44–2.25), who were treated in government hospitals (aOR: 1.45; 95% CI: 1.35–1.57), patients with the presence of lung diseases (aOR: 1.56; 95% CI: 1.35–1.80) had an increased likelihood of being prescribed Watch group antibiotics. Conclusions: This study reveals a concerning pattern of antibiotic overuse among SARI patients in Bangladesh, with a growing trend over the past decade towards increased Watch group antibiotic prescriptions. Only one-third of the prescribed antibiotics were from the Access group, falling short of the two-thirds threshold recommended by the WHO. Effective ASPs are crucial to optimize antibiotic prescriptions and mitigate the risk of antimicrobial resistance.

Candida auris ( C. auris ), an emerging fungus, is primarily recognized for causing healthcare-associated infections. While carriage among hospitalized patients is well documented, community spread remains poorly understood. This study aimed to determine the burden of community-acquired C. auris skin colonization among newly hospitalized participants without any recent healthcare exposure. This cross-sectional study was conducted at two tertiary-level government hospitals and their surrounding catchment areas in Dhaka, Bangladesh, from June 2023 to May 2024. We enrolled 800 participants (400 from each hospital) shortly after admission, meeting the following criteria: no healthcare exposure within the past three months, no invasive procedures performed since the current hospital admission, and residence within the hospital’s catchment area for the past three months. Skin swabs from the axillae and groins were cultured on CHROMagar Candida Plus to determine fungal colonization. Presumptive positive isolates were identified using VITEK 2, and C. auris was confirmed by whole-genome sequencing. No C. auris colonization was detected in the axillary or groin in any enrolled participant. However, 128 (16%) patients were found to be colonized with other fungal species. The absence of community-acquired C. auris colonization in this study suggests that transmission primarily occurs within hospital settings. However, our strict inclusion criteria, which excluded patients with recent healthcare exposure, may have influenced this finding. Further research using alternative study designs is needed to fully understand the potential for C. auris spread within the community. IMPORTANCE: Candida auris , a rapidly emerging multidrug-resistant fungal pathogen with high mortality, poses a critical global health threat, particularly in healthcare settings. While extensive research has focused on its colonization among hospitalized patients, its potential presence and community transmission remain largely unexplored. An earlier study among critically ill patients in Bangladesh detected four colonized cases of C. auris without hospitalization history within the past year and admitted directly from home (F. Chowdhury et al., unpublished data). Notably, three participants resided in the same district and one in an adjacent district, raising serious concerns about possible community spread. This study is crucial in addressing this knowledge gap by assessing the burden of community-acquired C. auris colonization among newly hospitalized patients in Dhaka. Understanding its potential transmission outside the hospital is vital for shaping public health responses, guiding infection control strategies, and strengthening global surveillance efforts to mitigate the spread of this highly resistant pathogen.

There is limited global evidence on whether influenza sentinel surveillance platforms can be effectively adapted for long-term SARS-CoV-2 monitoring in low-resource contexts. We explored the utility of the hospital-based influenza sentinel surveillance (HBIS) platform for monitoring SARS-CoV-2 in Bangladesh by comparing SARS-CoV-2 detection in HBIS platform with national COVID-19 platform and assessing how its integration into influenza surveillance aligns with national trends. From March 2020 to December 2024, we analysed data from patients with severe acute respiratory infection (SARI) and influenza-like illness (ILI) enrolled in HBIS. Socio-demographic and clinical data were recorded, and nasopharyngeal and oropharyngeal swabs were tested for influenza and SARS-CoV-2 using rRT-PCR. Whole-genome sequencing was performed on a subset of SARS-CoV-2-positive samples. Data from national COVID-19 platform were obtained from the Directorate General of Health Services, Bangladesh, and were compared with HBIS platform data using epidemic curves and Pearson correlation analysis. Among 25,366 (SARI: 20,226; ILI: 5140) patients, 13.0% (3310) tested positive for influenza, 6.6% (1680) for SARS-CoV-2, and 0.2% (43) were co-infected. SARS-CoV-2 positivity in HBIS (6.8%), including 0.2% co-infections, was lower than the national average (13.1%), but showed a strong correlation with national trends (Pearson r = 0.86, P < 0.001). Sequencing of 234 SARS-CoV-2 strains detected the beta and delta variants in April and May 2021, respectively, and omicron subvariants circulating from 2022 to 2024, aligning with the national COVID-19 platform. SARS-CoV-2 positivity trends in HBIS platform closely aligned with the national COVID-19 platform, demonstrating its potential as a sustainable platform for COVID-19 monitoring. Our findings underscore the feasibility of influenza sentinel surveillance as an early warning system for future COVID-19 outbreaks or other respiratory viruses of pandemic concern in Bangladesh and similar settings. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA (U01GH002259).

Invasive fungal infections (IFIs) remain underrecognized in low- and middle-income countries due to limited surveillance. This study aims to report the bur

Respiratory syncytial virus (RSV) is the leading cause of respiratory morbidity and mortality in children under five years of age, especially in low- and middle-income countries (LMICs). In 2023, two RSV immunisation options, including a maternal RSV vaccine and a monoclonal antibody (mAb), became approved in several high-income countries. The World Health Organization has recently prequalified the maternal vaccine and the Gavi has committed funding for its introduction, raising the prospect of RSV vaccine availability in LMICs in the near future. This analysis thus underscores the need for country-specific data on the burden of disease and seasonality, as well as the acceptability of new immunisation options and evaluations of their cost-effectiveness. Achieving successful implementation will require health system strengthening, targeted strategies to address unwillingness to vaccinate, securing sustainable financing for immunisation, and ensuring sustained policy commitment. As in many other LMICs, the RSV infection continues to pose a substantial public health concern in Bangladesh. However, evidence gaps persist regarding RSV epidemiology, healthcare system readiness, and public perceptions and willingness regarding new immunisation options. We use Bangladesh as a model to identify gaps, review available evidence, and outline strategies for integrating maternal vaccine and infant mAb into the country’s maternal and child health programmes. Lessons drawn from this case study may be directly applicable to other LMICs, offering a pathway to equitable adoption of these life-saving interventions and reducing the substantial global burden of RSV.