Prevalence and Impacts on Developed and Developing Countries

1. Prevalence and Impacts
on Developed and
Developing Countries

2. Methicillin-resistant S aureus
Infection Rates
Produced by CDDEP, found at: http://www.cddep.org/tool/mrsa_infection_rates_country#sthash.4eSoOCcP.zR0cdm2A.dpbs

3. Much greater than a third
world problem
 Prevalence of certain antibiotic resistant strains
(notably MRSA) a growing problem in many developed
countries1 – not just in developing countries
 USA and the UK were ranked among the countries with
the highest prevalence of MRSA infection rates
 Spread of resistance is facilitated by interspecies gene
transmission, poor sanitation and hygiene in
communities and hospitals, and the increasing
frequency of global, travel, trade, and disease
transmission1

4. Number of cases showing a resistance
causing genetic element by country
Produced by the IMF, found at: http://www.imf.org/external/pubs/ft/fandd/2014/12/jonas.htm

5. A Global Problem
 In high-income countries, continued high rates of
antibiotic use in hospitals, the community, and
agriculture have contributed to sustained resistant
strains, forcing a shift to more expensive and more
broad-spectrum antibiotics1
 In low-income and middle-income countries (LMICs),
antibiotic use is increasing with rising incomes, high
rates of hospitalization, and high prevalence of hospital
infections1

6. Mortality
 An estimated 25 000 people die every year in Europe
from antibiotic-resistant bacteria2
 A report conservatively estimated that at least 2 million
illnesses and 23 000 deaths a year in the USA were
caused by antibiotic resistance3
 Few reliable estimates are available for lower and
middle income countries, but the higher burden of
infectious disease and restricted access to new
antibiotics suggest a far higher burden than in high-
income countries1

7. Healthcare Associated Infections
 Incidence of infections acquired in intensive care units
in developing countries was three times the rate in the
USA4
 Health-care associated infections in neonatal intensive
care units in some developing countries are up to nine
times more common than in the USA4
 In lower and middle income countries the burden of
resistance seems only likely to increase with the rate of
health-care associated infections4

8. Increased Cost of Treatment
 A global need for more expensive antibiotics to treat
resistant infections has been driving up treatment costs
in both developing and developed countries1
 In lower and middle income countries, the ability to pay
for second-line drugs is limited when cheaper, first line
drugs are ineffective1
 Leads to much worse health outcomes, especially in
neonates1

9. Some Improvements
 Resistance to MRSA in some parts of Western Europe
has been decreasing5
 In high-income countries, it is being tackled with a
combination of new antibiotics and better hospital
infection control5
 Many of the lower and middle income countries have
been unable to implement many of these policies, and
have not seen the same improvements5
 See the following map5

12. References
1. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al.
Antibiotic resistance—the need for global solutions. The Lancet infectious diseases.
2013;13(12):1057-1098
2. ECDC/EMEA Technical Report. The bacterial challenge: time to react
http://www.ecdc.europa.eu/en/publications/Publications/0909_TER_The_Bacterial_Cha
llenge_Time_to_React.pdf (Sept 2009)
3. US Centers for Disease Control and Prevention Antibiotic resistance threats in the
United States, 2013 http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-
threats-2013-508.pdf (April 2013)
4. Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al.
Burden of endemic health-care-associated infection in developing countries: systematic
review and meta-analysis. The Lancet. 2011;377(9761):228-241.
5. Hede K. Antibiotic resistance: an infectious arms race. Nature. 2014;509(7498):S2-S3.