Impacts of Antimicrobial Resistance in Low-Income Settings

Alexander Aiken of the London School of Hygiene and Tropical Medicine in the United Kingdom will use the Matched Parallel Cohort (MPC) method in a multi-site study to measure the impact of antibiotic-resistant infections on mortality in low-income countries in sub-Saharan Africa. More complete data on antimicrobial resistance for this population is greatly needed, even though preliminary data suggests that mortality rates are likely higher than for high-income countries. The MPC method better controls confounding factors that can obscure the impact of antimicrobial resistance, such as duration in hospital, but requires more extensive data collection. In Phase I, they collected retrospective microbiological and clinical data from six African hospitals, and prospective data from one hospital, and used them to produce broad estimates of the attributable mortality of a particular form of antimicrobial resistance, which was lower than expected. In Phase II, in order to inform policymaking, they will expand their prospective study by collecting data including actual antibiotic use from 11 hospitals in 11 countries to produce a better estimate of the mortality impact of using inappropriate versus appropriate antibiotics for bacterial infections.