Socioeconomic Inequities Have a Significant Impact on Treatment of Antimicrobial Resistant Infections

According to the CDC, multidrug-resistant organisms (MDROs) are defined as microorganisms, predominantly bacteria, that are resistant to 1 or more antimicrobial agents.¹ Common MDROs include Methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant Enterobacteriaceae (CRE), and Pseudomonas aeruginosa.²

Antimicrobial resistant infections have the potential to spread widely | Image credit: © nobeastsofierce | stock.adobe.com

Targeted MDROs are organisms resistant to most or all available antimicrobials and have the potential to spread widely. This includes carbapenemase-producing Enterobacterales (CP-CRE), carbapenemase-producing Pseudomonas spp. (CP-CRPA), carbapenemase-producing Acinetbobacter baumanni (CP-CRAB), and Candida auris.² In 2021, it was estimated that 4.71 million deaths were associated with bacterial AMR, including 1.14 million deaths attributable to AMR.³ Therefore, MDROs require special attention in health care facilities, and public health initiatives are necessary to reduce the spread of those organisms.

Research has found that neighborhood-level socioeconomic status can also predict health.⁴ Neighborhoods with lower socioeconomic status are correlated with adverse environmental conditions, poor quality of housing, poor access to health care, and a lower social environment.⁴ Those conditions constrain the opportunities available for some residents to take measures that will reduce their risk of infectious diseases and limit their timely access to appropriate health care when needed.

In lower-middle-income countries, the impact of poverty on specific pathogens has been reported. In a 2018 systematic review published in Infectious Diseases of Poverty, lack of housing or homelessness was identified as a risk factor for MRSA infection in medically underserved patients with soft tissue infections in the United States.⁵ Moreover, there was a negative association between income and S. pneumoniae resistance where population-based surveillance for invasive pneumococcal disease linked with neighborhood-level census data, such as age, race, and address.⁶ In an article that discusses poverty and community-acquired antimicrobial resistance in India, 66.7% of women with ESBL-producing bacteria had household income below the median versus 50% of women without ESBL-producing bacteria.⁷

Antimicrobial resistance has a disastrous impact on today’s economy, especially with health care costs. In the United States alone, antibiotic resistance could add about $1400 to the hospital bill for treating patients with any bacterial infections.⁸ Increased costs associated with expensive and intensive treatments and escalation in resource utilization are the direct monetary effects of antimicrobial resistance in health care. A secondary effect of the direct costs is patients being pushed into extreme poverty as a result of antimicrobial resistance.⁸ Therefore, the economic cost can impact patients from low-income communities and countries.

Pharmacist awareness of health care disparities in socioeconomic status for multidrug-resistant organisms can significantly impact patient care for various infectious diseases. However, there have been challenges that community pharmacists in low-income countries encounter in tackling antimicrobial resistance.⁹ Community pharmacists in low-income countries often lack education and training in antimicrobial stewardship, which results in antibiotics being dispensed without a prescription.⁹ Community pharmacists in such countries also often lack awareness of the consequences of antimicrobial resistance, leading to detrimental clinical and socioeconomic effects.⁹ Moreover, community pharmacies in low-income countries have a higher patient load when compared with higher-income countries, decreasing the quality of patient education on antimicrobial therapy.⁹

These challenges inhibit the ability of patients to receive proper management of multidrug-resistant infections and contribute to the socioeconomic burden that lower-income countries face with antimicrobial-resistant infections. However, community pharmacists in low-income countries can play a crucial role in combating antimicrobial resistance through patient education about antibiotic use, identifying unnecessary prescriptions, and promoting responsible antibiotic dispensing.⁹ As a result, pharmacist-led interventions significantly improve antibiotic prescribing practices, optimize therapy, and improve patient outcomes.⁸

REFERENCES

1. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control. 2007;35(10 Suppl 2):S165-193. doi:10.1016/j.ajic.2007.10.006

2. MDRO Prevention Strategies. CDC. March 19, 2024. Accessed January 27, 2025. https://www.cdc.gov/healthcare-associated-infections/php/preventing-mdros/mdro-prevention-strategies.html

3. GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet. 2024;404(10459):1199-1226. doi:10.1016/S0140-6736(24)0186701

4. Zuniga-Chaves I, Eggers S, Kates AE, Safdar N, Suen G, Malecki KMC. Neighborhood socioeconomic status is associated with low diversity gut microbiomes and multi-drug-resistant microorganism colonization. NPJ Biofilms Microbiomes. 2023;9(1):61. doi:10.1038/s41522-023-00430-3

5. Alividza V, Mariano V, Ahmad R, et al. Investigating the impact of poverty on colonization and infection with drug-resistant organisms in humans: a systematic review. Infect Dis Poverty. 2018;7(1):76. doi:10.1186/s40249-018-0459-7

6. Chen FM, Breiman RF, Plikaytis B, Deaver K, Cetron MS. Geocoding and linking data from population-based surveillance and the US Census to evaluate the impact of median household income on the epidemiology of invasive Streptococcus pneumoniae infections. Am J Epidemiol. 1998;148(12):1212-1218. doi:10.1093/oxfordjournals.aje.a009611

7. Alsan M, Kammili N, Lakshmi J, et al. Poverty and community-acquired antimicrobial resistance with extended-spectrum b-lactamase-producing organisms, Hyderabad, India. Emerg Infect Dis. 2018;24(8):1490-1496. doi:10.3201/eid2408-171030

8. Dadgistar P. Antimicrobial resistance: implications and costs. Infect Drug Resist. 2019;12:3903-3910. doi:10.2147/IDR.S234610

9. Raju R. Srinivas SC, Siddalingegowda SM, Vaidya R, Gharat M, Kumar TMP. Community pharmacists as antimicrobial resistance stewards: a narrative review on their contributions and challenges in low- and middle-income countries. J Pharm Pharm Sci. 2024;27:12721. doi:10.3389/jpps.2024.12721