Background:Poverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics.Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and ...Background:Poverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics.Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and antimicrobial resistance.Investigating such relationship would strengthen antimicrobial stewardship interventions.Methods:A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.PubMed,Ovid,MEDLINE,EMBASE,Scopus,CINAHL,PsychINFO,EBSCO,HMIC,and Web of Science databases were searched in October 2016.Prospective and retrospective studies reporting on income or non-income dimensions of poverty and their influence on colonisation or infection with antimicrobial-resistant organisms were retrieved.Study quality was assessed with the Integrated quality criteria for review of multiple study designs(ICROMS)tool.Results:Nineteen articles were reviewed.Crowding and homelessness were associated with antimicrobial resistance in community and hospital patients.In high-income countries,low income was associated with Streptococcus pneumoniae and Acinetobacter baumannii resistance and a seven-fold higher infection rate.In low-income countries the findings on this relation were contradictory.Lack of education was linked to resistant S.pneumoniae and Escherichia coli.Two papers explored the relation between water and sanitation and antimicrobial resistance in low-income settings.Conclusions:Despite methodological limitations,the results suggest that addressing social determinants of poverty worldwide remains a crucial yet neglected step towards preventing antimicrobial resistance.展开更多
基金This work was supported by the National Institute for Health Research Health Protection Research Unit(NIHR HPRU)[grant No.HPRU-2012-10047]in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with Public Health England(PHE)ECS has received a Wellcome Trust ISFF Faculty postdoctoral fellowship,an Early Career Research Fellowship from the Antimicrobial Research Collaborative at Imperial College London,and acknowledges the support of the Florence Nightingale Foundation+2 种基金The views expressed are those of the author(s)and not necessarily those of the NHS,the NIHR,the Department of Health or Public Health EnglandThe funder of the study had no role in the study design,data collection,data analysis,data interpretation,or writing of the reportThe corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
文摘Background:Poverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics.Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and antimicrobial resistance.Investigating such relationship would strengthen antimicrobial stewardship interventions.Methods:A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.PubMed,Ovid,MEDLINE,EMBASE,Scopus,CINAHL,PsychINFO,EBSCO,HMIC,and Web of Science databases were searched in October 2016.Prospective and retrospective studies reporting on income or non-income dimensions of poverty and their influence on colonisation or infection with antimicrobial-resistant organisms were retrieved.Study quality was assessed with the Integrated quality criteria for review of multiple study designs(ICROMS)tool.Results:Nineteen articles were reviewed.Crowding and homelessness were associated with antimicrobial resistance in community and hospital patients.In high-income countries,low income was associated with Streptococcus pneumoniae and Acinetobacter baumannii resistance and a seven-fold higher infection rate.In low-income countries the findings on this relation were contradictory.Lack of education was linked to resistant S.pneumoniae and Escherichia coli.Two papers explored the relation between water and sanitation and antimicrobial resistance in low-income settings.Conclusions:Despite methodological limitations,the results suggest that addressing social determinants of poverty worldwide remains a crucial yet neglected step towards preventing antimicrobial resistance.
