Syndemics of Antimicrobial Resistance: Non-communicable Diseases, Social Deprivation, and the Rise of Multidrug-Resistant Infections

Abstract

Antimicrobial resistance (AMR) constitutes a global health emergency that results in significant morbidity, mortality, and economic burden. Despite its severity, this issue remains inadequately addressed in public health discussions worldwide. This commentary employs a syndemic perspective to explore the synergistic relationship between multidrug-resistant (MDR) infections and non-communicable chronic diseases (NCDs). NCDs, including cardiovascular disease, chronic respiratory conditions, cancer, and diabetes mellitus, are prevalent among socially deprived populations, creating conditions that facilitate bacterial colonization and worsen disease severity, thus heightening the risk of infection and resulting in poorer clinical outcomes. Conversely, MDR infections can also exacerbate NCDs by provoking inflammatory responses and disrupting homeostasis. The commentary further underscores how social determinants of health (SDoH), such as economic hardship, limited access to healthcare, and lower educational attainment, intensify this syndemic relationship, particularly in low- and middle-income countries (LMICs) and among socially deprived populations in high-income countries. In conclusion, we provide actionable recommendations for clinicians to consider when identifying and addressing syndemics in AMR. Embracing a syndemic approach to combat AMR may yield more effective strategies to alleviate the AMR "silent pandemic," especially benefiting populations disproportionately impacted by overlapping social, economic, and health vulnerabilities.

Keywords: Antimicrobial resistance; Multidrug-resistant infections; Non-communicable diseases; Poverty; Social deprivation; Social vulnerability; Syndemic.

Fig. 1

Syndemic model for NCDs, MDR infections, and social deprivation