Socioeconomic disparities may increase rate of antimicrobial-resistant organisms
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Key takeaways:
- Areas with high socioeconomic disparities are more likely to have higher rates of resistant organisms.
- AmpC beta-lactamase Gram negative organisms and MRSA had the greatest amount of clustering.
Socioeconomic disparities among residential neighborhoods may be associated with the prevalence of five specific antimicrobial-resistant organisms, especially AmpC beta-lactamase producers and methicillin resistant Staphylococcus aureus.
“There is evidence for the relationship between socioeconomic disparities and other disease processes (cardiovascular disease, malignancy etc.). In terms of infectious diseases, COVID-19 highlighted these disparities; however, there is little evidence looking at the relationship of antimicrobial resistance and health disparities,” Lauren N. Cooper, MS, a data scientist at the University of Texas Southwestern Medical Center., told Healio.
“By including geospatial analyses, the understanding of this relationship can be further developed, in addition to discovering geographic locations of higher antimicrobial resistance prevalence,” she said.
To assess these disparities, the researchers collected select patient bacterial culture results from 2015 to 2020 from electronic health records of two expansive health care systems within the Dallas-Fort Worth, Texas metropolitan area.
Case counts for each organism studied were standardized per 1,000 persons per area population and spatial autocorrelation tests were used to identify geographic clusters of high and low antimicrobial resistant organism prevalence.
In total, 32,897 patients from two health systems were included in the study, with 43,677 unique cultures for five resistant organisms of interest — methicillin resistant S. aureus (MRSA), vancomycin resistant Enterococcus (VRE), carbapenem resistant Enterobacterales (CRE), and extended spectrum beta-lactamase producers (ESBL) — between 2015 and 2020.
Among the cultures researchers analyzed, 19,019 (43.5%) were identified as MRSA, 13,555 (31%) as ESBL producing organisms, 11.3% as CRE, 8.2% as VRE, and 5.9% as AmpC.
Overall, the study showed a significant geospatial association between a well-known socioeconomic disparity index and the prevalence of antimicrobial resistance, with AmpC beta-lactamase Gram negatives and MRSA showing the greatest amount of clustering.
Specifically, the study showed that approximately 62% of the variability in AmpC rates, 49% of MRSA rates and 46% of ESBL rates can be attributed to relationships with neighboring census tracts (P < .001).
“Clinicians need to be aware of the strong relationship between socioeconomic disparities and the prevalence of antimicrobial resistance,” Cooper said. “Taking into account ADI may aid in determining empiric antibiotic selection and provide a platform for further enhancing personalized antibiotic recommendations.”
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