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A nationwide analysis of a large, geographically diverse cohort of adults in the U.S. suggests there is an increased risk for hospital-acquired carbapenem-resistant enterobacterales (CRE) bloodstream infections among racial and ethnic minorities.

Felicia Ruffin, PhD, and David van Duin, MD, PhD

Felicia Ruffin, PhD, is a researcher at Duke University School of Medicine in the research group of Vance Fowler, MD, MHS. For this project, she was mentored by Dr. Fowler, as well as David van Duin, MD, PhD, a member of the UNC Institute for Global Health and Infectious Diseases. Ruffin investigated whether race, sex, and the interaction of race and sex, and clinical variables were associated with 30-day mortality, through the Antibacterial Resistance Leadership Group’s (ARLG) Multi-Drug Resistant Organism (MDRO) Network, led by Van Duin.

Of the 362 patients (aged 49 to 71 years) included in the study, 117 (32%) were Black, and 60 (17%) were Black women; 245 (68%) were White, and 104 (29%) were White women. Ruffin found that Black women had an increased risk of death compared with White women and Black men which may be due in part to hospitalizations for underlying comorbidities and associated with racial and biological sex inequities.

The study was supported by an EVERYONE grant, through the ARLG.

“These findings are deeply troubling,” said Ruffin in a press release. “Studies are rare that describe these disparities, and our analyses found that it is being both female and Black that is associated with an increased risk of dying.”

“Our study did not address the reasons for these disparities, but differences in comorbid conditions affecting the immune response emerged as a possibility for the differences in the outcomes. Additional research is needed to uncover the social determinants of health outcomes. Barriers to access to medical care, socioeconomic status, differences in antibiotic use, and health literacy about antimicrobial-resistance (AMR) may also contribute to these disparities, all of which can be associated with racial and biological sex inequities.”

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