Investigating the impact of poverty on colonization and infection with drug-resistant organisms in humans: a systematic review

Abstract

BackgroundPoverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics. Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and antimicrobial resistance. Investigating such relationship would strengthen antimicrobial stewardship interventions.MethodsA systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Ovid, MEDLINE, EMBASE, Scopus, CINAHL, PsychINFO, EBSCO, HMIC, and Web of Science databases were searched in October 2016. Prospective and retrospective studies reporting on income or non-income dimensions of poverty and their influence on colonisation or infection with antimicrobial-resistant organisms were retrieved. Study quality was assessed with the Integrated quality criteria for review of multiple study designs (ICROMS) tool.ResultsNineteen articles were reviewed. Crowding and homelessness were associated with antimicrobial resistance in community and hospital patients. In high-income countries, low income was associated with Streptococcus pneumoniae and Acinetobacter baumannii resistance and a seven-fold higher infection rate. In low-income countries the findings on this relation were contradictory. Lack of education was linked to resistant S. pneumoniae and Escherichia coli. Two papers explored the relation between water and sanitation and antimicrobial resistance in low-income settings.ConclusionsDespite methodological limitations, the results suggest that addressing social determinants of poverty worldwide remains a crucial yet neglected step towards preventing antimicrobial resistance.Electronic supplementary materialThe online version of this article (10.1186/s40249-018-0459-7) contains supplementary material, which is available to authorized users.

An urgent need for antimicrobial stewardship in Indigenous rural and remote primary health care

“…A critical knowledge gap is the relative contribution of the social determinants of health to AMR in remote communities. Overseas studies have linked community poverty to AMR and underscored the importance of poor sanitation and access to clean water as drivers of AMR spread . AMR in remote Australian communities will likely continue increasing unless infections are prevented, thus reducing the need for antimicrobial use.…”

Accelerating the sustainable development goals through microbiology: some efforts and opportunities

“…This economic burden ranged from $21.832 per case to over $3 trillion global loss in gross domestic product (GDP). Another systematic study on poverty and AMR in humans concluded that antimicrobial resistance is interlinked with poverty [ 8 ]. The relationship between poverty and infectious disease is problematic since infectious diseases do not respect socio-economic status.…”

Epidemiology of methicillin resistant Staphylococcus species carriage in companion animals in the Greater Brisbane Area, Australia

“…Nevertheless, the ndings from this study are useful to uncover the landscape epidemiology of MRS carriage in Australian dogs. Second, the ecological nature of our model could have contributed to a lack of statistical support for the socioeconomic variable which as previously been postulated to be an important factor in antimicrobial resistant bacteria epidemiology, including MRSA (56,57). While SEIFA scores were signi cant at the univariable analysis the fact that the SEIFA scores were available at the postcode level could have contribute to the loss of statistical support due to presence of regression dilution bias (58).…”