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

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

Raspail Carrel Founou  1   2 , Luria Leslie Founou  1   3 , Sabiha Yusuf Essack  1
Affiliations
Review

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

Raspail Carrel Founou et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

Competing Interests: S.Y. Essack is a member of the Global Respiratory Infection Partnership and Global Analgesic Steering Committee sponsored by Reckitt and Benckiser. The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig 1
Fig 1. Prisma Flow-chart illustrating the study selection process.
Fig 2
Fig 2. Graphical representation of AMR in developing countries included in the study.
Fig 3
Fig 3. Forest plot of impact of ABR on mortality and sub-group analyses per World Bank classification, WHO regions, countries, group of bacteria and bacteria species.
3A. Forest plot of overall impact of antibiotic-resistance on mortality in included studies. 3B. Forest plot of impact of ABR on mortality analyzed per World Bank Classification. 3C. Forest plot of impact of ABR on mortality analyzed per WHO regions. 3D. Forest plot of impact of ABR on mortality analyzed per countries. 3E. Forest plot of impact of AMR on mortality analyzed per group of bacteria. 3F. Forest plot of impact of ABR on mortality analyzed per bacterial species.
Fig 4
Fig 4. Funnel plot of standard error by log odds ratio.
See this image and copyright information in PMC

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References

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Grants and funding

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.