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

Abstract

The decreasing effectiveness of antimicrobial agents is a global public health threat, yet risk factors for community-acquired 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 urban-dwelling 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.

Extended‐spectrum beta‐lactamase (ESBL)‐producingEnterobacteriaceaeand urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

“…Likewise, in India where most studies included in the presented study had been performed, prevalence of ESBL‐P Enterobacteriaceae in a study performed in 2004 was 35.9% . In a recent study carried out in 2016 in India, this prevalence rose to 57.1% …”

“…38 In a recent study carried out in 2016 in India, this prevalence rose to 57.1%. 34 In a previous prospective study regarding antibiotic treatment of women with recurrent AB, the authors reported that women treated with antibiotic in fact had more recurrent episodes (4.4 times higher)…”

“…America, 32 12 studies in Asia, [33][34][35][36][37][38][39][40][41][42][43][44] and 2 studies in Europe. 45,46 We contacted authors of 20 studies for more clarifications about their reports.…”

“…For studies that lasted for more than 12 months, the midyear of the study period that actual sampling and laboratory evaluation was done was determined as the date of the study. Nine studies reported data on patients with symptomatic UTI, 24,27,29,[31][32][33]43,44,46 nine reported AB, 25,26,[34][35][36][37][40][41][42] and infection type in five studies 28,30,38,39,45 were indeterminate. Two studies included postpartum women.…”

Desigualdades sociales relacionadas con la resistencia a antimicrobianos de N. gonorrhoeae en Colombia

“…La evidencia previa a este estudio permitió explicar correlaciones de determinantes con la RAM (18,19); sin embargo, no se ha dado suficiente importancia a la medición de desigualdades en la RAM de la N. gonorrhoeae. Colombia ofrece una oportunidad para investigarla aprovechando los desarrollos del Sistema de Información de la Protección Social (SISPRO).…”