Multidrug-resistant infections in low-resource health care settings

Abstract

The confluence of a high burden of infections, overcrowded conditions, poor hygiene, and lack of access to newer antibiotics in large, urban, public hospitals in poor countries is leading to higher reported levels of antibiotic resistance. Most resistance data come from the sickest patients and those who do not respond to any antibiotics; therefore, reported rates may overstate the problem. Nevertheless, it is evident that lack of diagnostic and other microbiologic resources encourage overtreatment and contribute to mistreatment in hospitals. High national death rates from childhood pneumonia in the community indicate a lack of access and underuse. Hospital-acquired infections (HAIs) impose significant health costs in poor countries where people pay for health care out of pocket. Patients, especially neonates, are more likely to die for lack of effective treatment and are likely to be ill and infectious for longer, hence more likely to spread resistant organisms. Underused but highly cost-effective interventions include vaccination to reduce disease burden (benefiting the entire population, not just hospitals), improved hospital infection control (which can be relatively inexpensive), and changing incentives toward more appropriate antibiotic use.