TY - JOUR
T1 - Contribution of socio-economic factors in the spread of antimicrobial resistant infections in Australian primary healthcare clinics
AU - Wozniak, Teresa M.
AU - Cuningham, Will
AU - Ledingham, Katie
AU - McCulloch, Karen
N1 - Funding Information:
This work was funded by NIH grant R01 CA069544, R01CA176086 and NSFC 81370038, BNSF 7142012, BNP Z141101001814107, STPBMEC km201410005003,PSFC 2014M560032, 2015T80030, and BJUT 002000514312015, 2013-RXL04 .
Publisher Copyright:
© 2022 The Authors
PY - 2022/9
Y1 - 2022/9
N2 - Objectives: To effectively contain antimicrobial-resistant (AMR) infections, we must better understand the social determinates of health that contribute to transmission and spread of infections. Methods: We used clinical data from patients attending primary healthcare clinics across three jurisdictions of Australia (2007–2019). Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) isolates and their corresponding antibiotic susceptibilities were included. Using multivariable logistic regression analysis, we assessed associations between AMR prevalence and indices of social disadvantage as reported by the Australian Bureau of Statistics (i.e., remoteness, socio-economic disadvantage and average person per household). Results: This study reports 12 years of longitudinal data from 43 448 isolates from a high-burden low-resource setting in Australia. Access to health and social services (as measured by remoteness index) was a risk factor for increased prevalence of third-generation cephalosporin-resistant (3GC) E. coli (odds ratio 5.05; 95% confidence interval 3.19, 8.04) and methicillin-resistant S. aureus (MRSA) (odds ratio 5.72; 95% confidence interval 5.02, 6.54). We did not find a positive correlation of AMR and socio-economic disadvantage or average person per household indices. Conclusion: Remoteness is a risk factor for increased prevalence of 3GC-resistant E. coli and MRSA. We demonstrate that traditional disease surveillance systems can be repurposed to capture the broader social drivers of AMR. Access to pathogen-specific and social data early and within the local regional context will fill a significant gap in disease prevention and the global spread of AMR.
AB - Objectives: To effectively contain antimicrobial-resistant (AMR) infections, we must better understand the social determinates of health that contribute to transmission and spread of infections. Methods: We used clinical data from patients attending primary healthcare clinics across three jurisdictions of Australia (2007–2019). Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) isolates and their corresponding antibiotic susceptibilities were included. Using multivariable logistic regression analysis, we assessed associations between AMR prevalence and indices of social disadvantage as reported by the Australian Bureau of Statistics (i.e., remoteness, socio-economic disadvantage and average person per household). Results: This study reports 12 years of longitudinal data from 43 448 isolates from a high-burden low-resource setting in Australia. Access to health and social services (as measured by remoteness index) was a risk factor for increased prevalence of third-generation cephalosporin-resistant (3GC) E. coli (odds ratio 5.05; 95% confidence interval 3.19, 8.04) and methicillin-resistant S. aureus (MRSA) (odds ratio 5.72; 95% confidence interval 5.02, 6.54). We did not find a positive correlation of AMR and socio-economic disadvantage or average person per household indices. Conclusion: Remoteness is a risk factor for increased prevalence of 3GC-resistant E. coli and MRSA. We demonstrate that traditional disease surveillance systems can be repurposed to capture the broader social drivers of AMR. Access to pathogen-specific and social data early and within the local regional context will fill a significant gap in disease prevention and the global spread of AMR.
KW - Antibiotic resistance
KW - Australia
KW - Disease surveillance
KW - Remoteness
KW - Social determinants of health
UR - http://www.scopus.com/inward/record.url?scp=85135111613&partnerID=8YFLogxK
U2 - 10.1016/j.jgar.2022.06.005
DO - 10.1016/j.jgar.2022.06.005
M3 - Article
C2 - 35700913
AN - SCOPUS:85135111613
SN - 2213-7165
VL - 30
SP - 294
EP - 301
JO - Journal of Global Antimicrobial Resistance
JF - Journal of Global Antimicrobial Resistance
ER -