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Poverty and Community-Acquired Antimicrobial Resistance with Extended-Spectrum β-Lactamase–Producing Organisms, Hyderabad, India

Year: 2018

Type: article

Abstract: The decreasing effectiveness of antimicrobial agents is a global public health threat, yet risk factors for communityacquired antimicrobial resistance (CA-AMR) in low-income settings have not been clearly elucidated.Our aim was to identify risk factors for CA-AMR with extended-spectrum β-lactamase (ESBL)-producing organisms among urbandwelling women in India.We collected microbiological and survey data in an observational study of primigravidae women in a public hospital in Hyderabad, India.We analyzed the data using multivariate logistic and linear regression and found that 7% of 1,836 women had bacteriuria; 48% of isolates were ESBL-producing organisms.Women in the bottom 50th percentile of income distribution were more likely to have bacteriuria (adjusted odds ratio 1.44, 95% CI 0.99-2.10)and significantly more likely to have bacteriuria with ESBL-producing organisms (adjusted odds ratio 2.04, 95% CI 1.17-3.54).Nonparametric analyses demonstrated a negative relationship between the prevalence of ESBL and income.A ntimicrobial resistance (AMR) is a growing global public health threat that could reverse decades of progress in increasing longevity around the world (1).The rapid pace of AMR spread coupled with a shortage of novel antimicrobial agents has led the World Health Organization (WHO) to warn of a "postantimicrobial era" (2).By 2050, deaths attributable to AMR could exceed 10 million per year, more than the number of deaths from cancer and traffic accidents combined, while costing the global economy US $60-$100 trillion of economic output (3).Most policy recommendations for curtailing AMR are tailored to wealthy nations; however, the threat of AMR is also severe for poorer countries (4,5).Infectious diseases are still common causes of illness and death in such settings, and the availability of second-or third-line therapies is limited (6,7).Yet, detailed estimates of the prevalence of AMR in developing countries are limited and often rely on samples from returning travelers or in-country patients receiving care for suspected infectious diseases.These data point to an alarming rate of community-acquired AMR (CA-AMR) in extended-spectrum β-lactamase (ESBL)-producing organisms, including in Hyderabad, India, the setting of this study (8)(9)(10)(11).Such trends are of international concern given the possibility for AMR pathogens and genetic elements to spread across political and geographic boundaries.Because of the lack of detailed data from developing countries, empirical work on predictors of CA-AMR is generally limited to responses from wealthy countries or cross-country comparisons.These studies generally document robust positive relationships between antimicrobial drug use, healthcare provider contacts, and the prevalence of AMR (12-15).These strong links have led to the hypothesis that growing drug resistance in developing countries is attributable to rising incomes, which increase demand for many health products, including antimicrobial drugs (16-18).Yet, other factors that place the poor at greater risk for CA-AMR might be more pronounced in developing countries.First, the poor are more likely to be exposed to infectious agents from other humans and are at higher risk for illness because of malnutrition and immunodeficiency (4).Second, the poor are more likely to experience subinhibitory doses of antimicrobial agents because of shorter courses Poverty and Community-Acquired Antimicrobial Resistance with Extended-Spectrum β-Lactamase-Producing Organisms, Hyderabad, India

Source: Emerging infectious diseases

DOI: 10.3201/eid2408.171030