Cooper Lauren N, Beauchamp Alaina M, Ingle Tanvi A, Diaz Marlon I, Wakene Abdi D, Katterpalli Chaitanya, Keller Tony, Walker Clark, Blumberg Seth, Kanjilal Sanjat, Chen Jonathan H, Radunsky Alexander P, Most Zachary M, Hanna John J, Perl Trish M, Lehmann Christoph U, Medford Richard J
Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Clin Infect Dis. 2024 Dec 17;79(6):1346-1353. doi: 10.1093/cid/ciae313.
The increased prevalence of antimicrobial-resistant (AMR) infections is a significant global health threat, resulting in increased disease, deaths, and costs. The drivers of AMR are complex and potentially impacted by socioeconomic factors. We investigated the relationships between geographic and socioeconomic factors and AMR.
We collected select patient bacterial culture results from 2015 to 2020 from electronic health records of 2 expansive healthcare systems within the Dallas-Fort Worth, Texas, metropolitan area. Among individuals with electronic health records who resided in the 4 most populous counties in Dallas-Fort Worth, culture data were aggregated. Case counts for each organism studied were standardized per 1000 persons per area population. Using residential addresses, the cultures were geocoded and linked to socioeconomic index values. Spatial autocorrelation tests identified geographic clusters of high and low AMR organism prevalence and correlations with established socioeconomic indices.
We found significant clusters of AMR organisms in areas with high levels of deprivation, as measured by the area deprivation index (ADI). We found a significant spatial autocorrelation between ADI and the prevalence of AMR organisms, particularly for AmpC β-lactamase and methicillin-resistant Staphylococcus aureus, with 14% and 13%, respectively, of the variability in prevalence rates being attributable to their relationship with the ADI values of the neighboring locations.
We found that areas with a high ADI are more likely to have higher rates of AMR organisms. Interventions that improve socioeconomic factors such as poverty, unemployment, decreased access to healthcare, crowding, and sanitation in these areas of high prevalence may reduce the spread of AMR.
抗菌药物耐药性（AMR）感染患病率的上升是对全球健康的重大威胁，导致疾病增加、死亡人数上升和成本增加。AMR的驱动因素复杂，可能受到社会经济因素的影响。我们调查了地理和社会经济因素与AMR之间的关系。
我们从德克萨斯州达拉斯-沃思堡大都市地区两个大型医疗系统的电子健康记录中收集了2015年至2020年选定患者的细菌培养结果。在居住在达拉斯-沃思堡人口最多的4个县且拥有电子健康记录的个体中，对培养数据进行了汇总。所研究的每种生物体的病例数按每1000人/地区人口进行标准化。利用居住地址，对培养结果进行地理编码并与社会经济指数值相关联。空间自相关测试确定了AMR生物体高患病率和低患病率的地理集群以及与既定社会经济指数的相关性。
我们发现，以地区贫困指数（ADI）衡量，在贫困程度高的地区存在显著的AMR生物体集群。我们发现ADI与AMR生物体的患病率之间存在显著的空间自相关，特别是对于AmpCβ-内酰胺酶和耐甲氧西林金黄色葡萄球菌，患病率变化的14%和13%分别归因于它们与相邻地点ADI值的关系。
我们发现，ADI高的地区更有可能有较高的AMR生物体发生率。改善这些高流行地区社会经济因素（如贫困、失业、医疗服务可及性降低、拥挤和卫生条件）的干预措施可能会减少AMR的传播。
