Antimicrobial resistance in ICU endotracheal aspirates: Evidence to support stewardship in Bangladesh.

Ventilator-associated respiratory infections are a major cause of morbidity and mortality in mechanically ventilated ICU patients. Therefore, it is of interest to analyze endotracheal aspirates collected from adult ICU patients at Bangladesh Medical University between July 2024 to June 2025. Among 111 samples examined, 26.1% showed significant bacterial growth. Gram-negative bacilli predominated (96.6%) among the isolates. The most frequent pathogen was Pseudomonas aeruginosa (58.6%), followed by Acinetobacter baumannii, Klebsiella pneumoniae and Escherichia coli. High resistance was observed to third-generation cephalosporins, fluoroquinolones and aminoglycosides. Reduced susceptibility to carbapenems was also detected among P. aeruginosa and A. baumannii isolates. All Gram-negative isolates remained susceptible to colistin. The single Staphylococcus aureus isolate was susceptible to vancomycin. Thus, we show the predominance of multidrug-resistant Gram-negative pathogens in ventilated ICU patients. Institution-specific susceptibility data are essential to guide rational empiric therapy and support antimicrobial stewardship in resource-limited ICUs.