Poverty and Community-Acquired Antimicrobial Resistance with Extended-Spectrum β-Lactamase-Producing Organisms, Hyderabad, India

Emerg Infect Dis. 2018 Aug;24(8):1490-1496. doi: 10.3201/eid2408.171030.


The decreasing effectiveness of antimicrobial agents is a global public health threat, yet risk factors for community-acquired antimicrobial resistance (CA-AMR) in low-income settings have not been clearly elucidated. Our aim was to identify risk factors for CA-AMR with extended-spectrum β-lactamase (ESBL)-producing organisms among urban-dwelling women in India. We collected microbiological and survey data in an observational study of primigravidae women in a public hospital in Hyderabad, India. We analyzed the data using multivariate logistic and linear regression and found that 7% of 1,836 women had bacteriuria; 48% of isolates were ESBL-producing organisms. Women in the bottom 50th percentile of income distribution were more likely to have bacteriuria (adjusted odds ratio 1.44, 95% CI 0.99-2.10) and significantly more likely to have bacteriuria with ESBL-producing organisms (adjusted odds ratio 2.04, 95% CI 1.17-3.54). Nonparametric analyses demonstrated a negative relationship between the prevalence of ESBL and income.

Keywords: AMR; ESBL; India; antimicrobial resistance; bacteria; community-acquired antimicrobial resistance; environment; extended-spectrum beta-lactamase; poverty.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / pharmacology
  • Bacterial Infections / epidemiology*
  • Bacterial Infections / microbiology*
  • Bacteriuria / epidemiology
  • Bacteriuria / microbiology
  • Community-Acquired Infections / epidemiology*
  • Community-Acquired Infections / microbiology*
  • Cross-Sectional Studies
  • Drug Resistance, Multiple, Bacterial*
  • Female
  • Humans
  • India / epidemiology
  • Poverty*
  • Pregnancy
  • Risk Factors
  • Young Adult


  • Anti-Bacterial Agents