Understanding How Drug-resistant Infections Impact Vulnerable Populations
Who is Affected by Antimicrobial Resistance
In recognition of World AMR Awareness Week, we reflect on how the world has recognized and responded to public health crises and how the need for crises has affected vulnerable populations. In the case of HIV, hepatitis C, and the COVID-19 pandemic, it has been recognized that social determinants of health and related demographic factors, such as gender, ethnicity, and socioeconomic status, have contributed to disproportionately adverse outcomes.i,ii
The recent 2024 United Nations Political Declarations on Antimicrobial Resistance (AMR) recognized “the need to leave no one behind and to reach the most effective and equitable access to quality essential health services and safe and secure. , quality and affordable essential medicines, including antimicrobials and vaccines, diagnostics, pharmaceuticals and other health products”.x,i
Antimicrobial resistance: impacts, challenges
The misuse of antibiotics in human and animal health, as well as in agriculture, contributes to the spread of resistance genes
AMR has been called a “silent” pandemic, but the World Health Organization (WHO) recently listed AMR as one of 10 urgent health threats. Antimicrobial resistance threatens human and animal health and well-being, the environment, food security and safety, economic development and equity in societies.iii The US CDC is addressing health equity in AMR as part of the CDC CORE Initiative, an agency-wide strategy to increase public health equity. Health disparities associated with AMR can manifest in a variety of ways, affecting differences in transmission risk, susceptibility and treatment.
Like other public health crises, we are once again seeing signals of health disparities associated with AMR in vulnerable populations. A vulnerable patient can be identified by several factors, including patients who suffer from disproportionately high levels of disease, who have difficulty accessing care, who are disproportionately affected by their illness and outcomes, and who have limited control or input into their own health care.v,vi
Antibiotic resistance: what is it, complications & treatment
A recent study analyzed urinary tract infections caused by multidrug-resistant pathogens. It found that both young and elderly female patients (both vulnerable patient demographics for different reasons) were at increased risk of single- and multiple-drug resistance to first-line antibiotics. Increasingly, universal national guidelines may not reflect clinical need, as geography was also important in this study.
Higher drug resistance was found in zip codes that coincided with higher densities of POC (people of color) and lower socioeconomic income.vii This study provides real-world evidence (RWE) that identifies clinical gaps and impacts on vulnerable study populations. This type of data should be used to inform guidance and inform future studies.
Chemotherapy patients are another vulnerable population with a higher incidence of infection. As many as 1 in 5 cancer patients undergoing treatment will be hospitalized for an infection, and antibiotics are the main line of defense.viii A recent study showed that hospitalized cancer patients have a 2-fold higher incidence of resistant pathogens that cause life-threatening diseases.
Why is antibiotic resistance a problem
The bloodstream shows non-cancer pathogens.ix Looking more closely at the impact on cancer patients and other vulnerable people, it was found that transplant and myeloproliferative (MP) cancer patients with hospital-acquired bacteremia have a higher burden of treatment than patients who did not have either.x,i
High rates of drug resistance limit the options available to physicians in treating their patients and can lead to higher mortality, longer hospital stays, and higher costs. Antibiotics are an indispensable part of cancer treatment – Weight Management patients simply have to take them – and their use is essential to better manage and cope with the crisis.
These findings are not limited to the United States, but are being replicated worldwide. Drug-resistant bacterial pathogens (excluding Mycobacterium tuberculosis) are estimated to be responsible for approximately 5.0 million deaths per year, of which 4.3 million occur in low- and middle-income countries (LMICs).vi
Why is antibiotic resistance a serious problem?
We are at a turning point with AMR. We have a clear call to action from the United Nations Declaration on Antimicrobial Resistance – countries have committed to reducing the number of deaths from bacterial AMR by 10% by 2030. Let us learn from historical public health crises and not repeat the same mistakes with AMR. Actions we can take today to reduce the burden of drug-resistant infections, wounds and the impact on patients worldwide include:
Increase the alliance between health systems, public health policy and industry
Identify gaps in clinical care that need to be addressed using evidence
Address clinical AMR gaps by developing metrics of progress based on regionally supported existing.
Why is antibiotic resistance a problem in developing countries?
The threat posed by these resistant bacteria is however exacerbated in developing countries due to sub-optimal hygiene conditions, poor infection, prevention and control measures, lack of surveillance and the dearth antimicrobial stewardship programs.
Source:
Action is Needed to Slow Drug-resistant Infections in Vulnerable Populations
Kalvin Yu, Vice President, Bd Medical Affairs North America;
Diane Flayhart, Director, Bd Global Public Health