Poverty and root causes of resistance in developing countries

Abstract

Antimicrobial use provides selective pressure for resistant strains but there are other factors that combine with use to promote the emergence and spread of resistant bacteria, mobile elements, and genes. Many of these factors are only superficially understood, if at all, and are complicated to study. Comparative antimicrobial resistance data from populations with different risk factors for resistance are hard to come by and inevitably suffer from bias. Nonetheless, a few studies document regional variations in resistance and some provide clues about factors that might exacerbate resistance. Data from these studies appear to suggest that antimicrobial misuse, prophylactic use, diagnostic imprecision, and interpersonal spread are key factors in the selection and dissemination of resistant strains. All these factors are promoted by poverty at the individual patient, health system, and national levels.