Socioeconomic Enablers for Contagion: Factors Impelling the Antimicrobial Resistance Epidemic

Abstract

Antimicrobial resistance is a growing global problem that causes increased deaths as well as increased suffering for people. Overall, there are two main factors that drive antimicrobial resistance: the volumes of antimicrobials used and the spread of resistant micro-organisms along with the genes encoding for resistance. Importantly, a growing body of evidence points to contagion (i.e., spread) being the major, but frequently under-appreciated and neglected, factor driving the increased prevalence of antimicrobial resistance. When we aggregate countries into regional groupings, it shows a pattern where there is an inverse aggregate relationship between AMR and usage. Poor infrastructure and corruption levels, however, are highly and positively correlated with antimicrobial resistance levels. Contagion, antibiotic volumes, governance, and the way antibiotics are used are profoundly affected by a host of social and economic factors. Only after we identify and adequately address these factors can antimicrobial resistance be better controlled.

Keywords: antibiotics; antimicrobial resistance; corruption; governance; infrastructure; sewage; social factors; water.

Figure 1

Percent resistance in E. coli to third-generation cephalosporins (3GCeph) and fluoroquinolones (FQ). Source Data: Collignon et al. (2018) [15] and figure from Collignon and McEwen [6].

Figure 2

Improved sanitation versus resistance percentage of E. coli to 3rd-generation cephalosporins and fluoroquinolones. Globally, these antibiotic resistance levels are inversely related to usage volumes but strongly related to sanitation levels. Source Data: Collignon et al. (2018) [15] and World Health Statistics, WHO, (2011) [16].