Short Communication
Poverty and prevalence of antimicrobial resistance in invasive isolates

https://doi.org/10.1016/j.ijid.2016.09.026Get rights and content
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Highlights

  • The association between the income status of a country and the prevalence of antimicrobial resistance (AMR) was examined.

  • A strong association was found between the income status of a country and the prevalence of AMR.

  • The association was stronger for third-generation cephalosporin-resistant Escherichia coli and Klebsiella sp than for methicillin-resistant Staphylococcus aureus.

Summary

Objectives

To evaluate the association between the income status of a country and the prevalence of antimicrobial resistance (AMR) in the three most common bacteria causing infections in hospitals and in the community: third-generation cephalosporin (3GC)-resistant Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA), and 3GC-resistant Klebsiella species.

Methods

Using 2013–2014 country-specific data from the ResistanceMap repository and the World Bank, the association between the prevalence of AMR in invasive samples and the gross national income (GNI) per capita was investigated through linear regression with robust standard errors. To account for non-linear association with the dependent variable, GNI per capita was log-transformed.

Results

The models predicted an 11.3% (95% confidence interval (CI) 6.5–16.2%), 18.2% (95% CI 11–25.5%), and 12.3% (95% CI 5.5–19.1%) decrease in the prevalence of 3GC-resistant E. coli, 3GC-resistant Klebsiella species, and MRSA, respectively, for each log GNI per capita. The association was stronger for 3GC-resistant E. coli and Klebsiella species than for MRSA.

Conclusions

A significant negative association between GNI per capita and the prevalence of MRSA and 3GC-resistant E. coli and Klebsiella species was found. These results underscore the urgent need for new policies aimed at reducing AMR in resource-poor settings.

Keywords

Antimicrobial resistance
Antibiotic
Low- and middle-income countries
Sanitation
Poverty

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