Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis

PLoS One. 2017 Dec 21;12(12):e0189621. doi: 10.1371/journal.pone.0189621. eCollection 2017.


Introduction: Despite evidence of the high prevalence of antibiotic resistant infections in developing countries, studies on the clinical and economic impact of antibiotic resistance (ABR) to inform interventions to contain its emergence and spread are limited. The aim of this study was to analyze the published literature on the clinical and economic implications of ABR in developing countries.

Methods: A systematic search was carried out in Medline via PubMed and Web of Sciences and included studies published from January 01, 2000 to December 09, 2016. All papers were considered and a quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS).

Results: Of 27 033 papers identified, 40 studies met the strict inclusion and exclusion criteria and were finally included in the qualitative and quantitative analysis. Mortality was associated with resistant bacteria, and statistical significance was evident with an odds ratio (OR) 2.828 (95%CI, 2.231-3.584; p = 0.000). ESKAPE pathogens was associated with the highest risk of mortality and with high statistical significance (OR 3.217; 95%CIs; 2.395-4.321; p = 0.001). Eight studies showed that ABR, and especially antibiotic-resistant ESKAPE bacteria significantly increased health care costs.

Conclusion: ABR is associated with a high mortality risk and increased economic costs with ESKAPE pathogens implicated as the main cause of increased mortality. Patients with non-communicable disease co-morbidities were identified as high-risk populations.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Developing Countries*
  • Drug Resistance, Microbial*
  • Health Care Costs*
  • Humans

Grant support

This study was supported by the Antimicrobial Research Unit and the College of Health Sciences of the University of KwaZulu-Natal through a scholarship awarded to R.C. Founou and L.L. Founou as well as the National Research Foundation South African Research Chair in Antibiotic Resistance and One Health Grant No: 98342 awarded to SY Essack. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.