Neighborhood deprivation, antimicrobial resistance, and mortality in patients with Enterobacterales: A retrospective cohort study

Abstract

Objectives: Antimicrobial resistance disproportionately affects socioeconomically disadvantaged populations. We examined how neighborhood deprivation relates to prevalence of antimicrobial resistance and 30-day all-cause mortality among individuals with Enterobacterales clinical isolates. Methods: We performed an observational cohort study, using data from electronic health records, among adult (≥18 years) patients of a North Carolina health system who had Enterobacterales isolated from a non-urinary source during 2014–2023. The outcome of interest was 30-day mortality from any cause; exposures of interest were phenotypic non-susceptibility to specific antibiotic classes and multidrug resistance. We assessed non-susceptibility prevalence by neighborhood deprivation level and estimated mortality hazard ratios comparing patients from high versus low deprivation neighborhoods, stratified by isolate susceptibility. Results: 21,950 patients were included in the study, of whom 2656 (12 %) died within 30 days. Mortality was 673/6046 (11 %), 942/7911 (12 %), and 1041/7993 (13 %) in the low, middle, and high deprivation groups, respectively. Non-susceptibility to each antibiotic class and multidrug resistance were more common in isolates from patients residing in high deprivation neighborhoods. Adjusted hazard ratios indicated a 61 % increase in 30-day mortality for high versus low deprivation neighborhoods among patients with multidrug resistant isolates (aHR 1.61, 95 % CI: 1.24–2.10). Among patients with non-multidrug resistant isolates, there was no difference in 30-day mortality by deprivation level (aHR 1.00, 95 % CI: 0.84–1.19). Conclusion: High neighborhood deprivation is associated with both an increased prevalence of antimicrobial resistance among Enterobacterales isolates and an increased risk of 30-day all-cause mortality among patients with non-susceptible isolates. Addressing antimicrobial resistance effectively must consider existing disparities in healthcare access and outcomes.

Keywords

• Enterobacterales
• Antimicrobial resistance
• Epidemiology
• Area deprivation
• Mortality
• Social determinants of health