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.
Highlights
Antimicrobial resistance (AMR) is a growing global public health threat that could reverse decades of progress in increasing longevity around the world [1]
Detailed estimates of the prevalence of AMR in developing countries are limited and often rely on samples from returning travelers or in-country patients receiving care for suspected infectious diseases. These data point to an alarming rate of community-acquired AMR (CA-AMR) in extended-spectrum β-lactamase (ESBL)–producing organisms, including in Hyderabad, India, the setting of this study [8,9,10,11]
To reduce the probability that AMR was acquired through a healthcare contact or activity, our study population consisted of women who were carrying a pregnancy to term for the first time and had never been hospitalized for a pregnancy
Summary
Antimicrobial resistance (AMR) is a growing global public health threat that could reverse decades of progress in increasing longevity around the world [1]. Detailed estimates of the prevalence of AMR in developing countries are limited and often rely on samples from returning travelers or in-country patients receiving care for suspected infectious diseases These data point to an alarming rate of community-acquired AMR (CA-AMR) in extended-spectrum β-lactamase (ESBL)–producing organisms, including in Hyderabad, India, the setting of this study [8,9,10,11]. Because of the lack of detailed data from developing countries, empirical work on predictors of CA-AMR is generally limited to responses from wealthy countries or cross-country comparisons These studies generally document robust positive relationships between antimicrobial drug use, healthcare provider contacts, and the prevalence of AMR [12,13,14,15]. We complemented our microbiological sample collection with a detailed survey on sociodemographic information and assessed AMR risk factors using the US Demographic and Health Surveys tool AMR Module for Population-Based Surveys [26,27]
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