Socioeconomic factors associated with antimicrobial resistance in Latin America: A systematic review and empirical analysis of 41 Chilean hospitals

Abstract

Background: The emergence and spread of antimicrobial resistance (AMR) is one of the most urgent global public health threats. Although frequently overlooked, the dissemination of antimicrobial resistance is also affected by socioeconomic factors, including inadequate water, sanitation, and hygiene (WASH), living conditions, waste management, and educational level. Therefore, these factors could be important predictors of AMR dissemination in poor contexts, such as Latin America, a region with several competing health priorities, limited health resources, deficient WASH infrastructure, uneven healthcare access, extreme poverty, and ubiquitous economic inequality. Recent OECD estimates indicate that AMR in Latin America ranges from 21% to 40%, as well as poverty rates according to the World Bank. Thus, articulating social policies to prevent and control the dissemination of AMR isolating the socioeconomic linkage is crucial. Methods and materials: We systematically reviewed the scientific literature on socioeconomic factors associated with the emergence and dissemination of antimicrobial resistance globally and in Latin America. Using multivariate regressions, we empirically tested the findings from the literature review drawing from a longitudinal dataset of antimicrobial resistance for P. aeruginosa, S. aureus, and E. coli from 41 major private and public hospitals and a nationally representative household survey in Chile (2008–2017). Results: Evidence from the systematic literature review suggest poverty and material deprivation are important risk factors for the emergence and transmission of antimicrobial resistance. Most studies, globally and in Latin America, found that worse socioeconomic indicators were associated with higher rates of antimicrobial resistance. The empirical analysis of our sample of 41 hospitals in Chile showed an overall antimicrobial resistance rate of 21.7%, with the highest rates for P. aeruginosa (26.1%) and the lowest for E. Coli (18.6%). We found a small, but consistent negative association between socioeconomic factors (income, education and occupation) and overall antimicrobial resistance rate in the univariate (p < 0.01) and multivariate analyses (p < 0.03), driven by resistant P. aeruginosa and S. aureus. Conclusion: Our results underscore the importance of socioeconomic factors beyond healthcare and hospital settings that may affect the emergence and dissemination of antimicrobial resistance. Preventing and controlling antimicrobial resistance will require efforts above and beyond reducing antibiotic consumption, particularly in Latin America.