Trends and socioeconomic, demographic, and environmental factors associated with antimicrobial resistance: a longitudinal analysis in 39 hospitals in Chile 2008-2017.

Autor:	Allel K; Institute for Global Health, University College London, UK.; Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.; Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK.; Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Chile., Labarca J; Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Chile.; Departamento de Enfermedades Infecciosas, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile.; Grupo Colaborativo de Resistencia Bacteriana, Sociedad Chilena de Infectología, Chile., Carvajal C; Departamento de Enfermedades Infecciosas, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile.; Grupo Colaborativo de Resistencia Bacteriana, Sociedad Chilena de Infectología, Chile., Garcia P; Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Chile.; Departamento de Laboratorios Clínicos, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, RM, Chile., Cifuentes M; Grupo Colaborativo de Resistencia Bacteriana, Sociedad Chilena de Infectología, Chile.; Hospital Clínico Universidad de Chile, Santiago, RM, Chile., Silva F; Grupo Colaborativo de Resistencia Bacteriana, Sociedad Chilena de Infectología, Chile.; Hospital Clínico Universidad de Chile, Santiago, RM, Chile., Munita JM; Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Chile.; Instituto de Ciencias e Innovacion en Medicina (ICIM), Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, RM, Chile., Undurraga EA; Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Chile.; Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, RM, Chile.; Centro de Investigación para la Gestión Integrada del Riesgo de Desastres (CIGIDEN), Chile.; CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Canada.
Jazyk:	angličtina
Zdroj:	Lancet regional health. Americas [Lancet Reg Health Am] 2023 Apr 06; Vol. 21, pp. 100484. Date of Electronic Publication: 2023 Apr 06 (Print Publication: 2023).
DOI:	10.1016/j.lana.2023.100484
Abstrakt:	Background: Antimicrobial resistance (AMR) is among the most critical global health threats of the 21st century. AMR is primarily driven by the use and misuse of antibiotics but can be affected by socioeconomic and environmental factors. Reliable and comparable estimates of AMR over time are essential to making public health decisions, defining research priorities, and evaluating interventions. However, estimates for developing regions are scant. We describe the evolution of AMR for critical priority antibiotic-bacterium pairs in Chile and examine their association with hospital and community-level characteristics using multivariate rate-adjusted regressions. Methods: Drawing on multiple data sources, we assembled a longitudinal national dataset to analyse AMR levels for critical priority antibiotic-bacterium combinations in 39 private and public hospitals (2008-2017) throughout the country and characterize the population at the municipality level. We first described trends of AMR in Chile. Second, we used multivariate regressions to examine the association of AMR with hospital characteristics and community-level socioeconomic, demographic, and environmental factors. Last, we estimated the expected distribution of AMR by region in Chile. Findings: Our results show that AMR for priority antibiotic-bacterium pairs steadily increased between 2008 and 2017 in Chile, driven primarily by Klebsiella pneumoniae resistant to third-generation cephalosporins and carbapenems, and vancomycin-resistant Enterococcus faecium . Higher hospital complexity, a proxy for antibiotic use, and poorer local community infrastructure were significantly associated with greater AMR. Interpretation: Consistent with research in other countries in the region, our results show a worrisome increase in clinically relevant AMR in Chile and suggest that hospital complexity and living conditions in the community may affect the emergence and spread of AMR. Our results highlight the importance of understanding AMR in hospitals and their interaction with the community and the environment to curtail this ongoing public health crisis. Funding: This research was supported by the Agencia Nacional de Investigación y Desarrollo (ANID), Fondo Nacional de Desarrollo Científico y Tecnológico FONDECYT, The Canadian Institute for Advanced Research (CIFAR), and Centro UC de Políticas Públicas, Pontificia Universidad Católica de Chile. Competing Interests: The authors declare no conflict of interests. (© 2023 The Author(s).)
Databáze:	MEDLINE
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