High neighborhood deprivation is linked to both greater antimicrobial resistance and higher short‑term mortality in Enterobacterales infections. For North Carolina, the implications are clear. Tackling AMR requires not only new drugs and diagnostics but also addressing healthcare disparities that leave vulnerable populations at greater risk.
Chapel Hill, NC — A new study published in CMI Communications finds patients living in socioeconomically disadvantaged neighborhoods face significantly higher risks from antimicrobial‑resistant Enterobacterales infections, including increased short‑term mortality.
Researchers at the UNC Institute for Global Health and Infectious Diseases, led by Heather Henderson, DVM, MPH, PhD, and David van Duin, MD, PhD, analyzed data through the North Carolina health system from 21,950 patients treated between 2014 and 2023, finding socioeconomic disadvantage is associated with antimicrobial resistance in Enterobacterales, a major family of gram‑negative bacteria, and with 30‑day mortality among patients.
Enterobacterales are bacteria commonly found in the human digestive tract and other environments. While many species are harmless and play a role in digestion, some can cause serious infections like urinary tract infections, bloodstream infections, and pneumonia.
“What we found is striking: higher neighborhood deprivation was linked to more resistant infections, and to higher mortality in patients with resistant isolates,” said Henderson, assistant professor of medicine in infectious diseases. “In contrast, deprivation did not increase mortality risk when infections were susceptible to antibiotics.”
About the Study
The study suggests poverty, housing, and access to healthcare can interact with bacterial resistance to worsen outcomes. While patients with susceptible isolates showed no difference in mortality by neighborhood, resistance combined with deprivation proved deadly.
- Multidrug resistance prevalence was 20% in high‑deprivation areas compared to 17% in low‑deprivation areas.
- Mortality rates rose with deprivation: 13% in high‑deprivation neighborhoods versus 11% in low‑deprivation neighborhoods.
- Critically, patients with multidrug‑resistant isolates from high‑deprivation neighborhoods had a 61% higher risk of death within 30 days compared to those from low‑deprivation areas.
“For North Carolina, the implications are clear,” Henderson said. “Many regions of the state face high socioeconomic disadvantage and health disparities. The link between neighborhood deprivation and antimicrobial resistance suggests that place‑based vulnerabilities contribute to geographic variation in resistant infections and their consequences. Public health strategies will be more effective if they are tailored to the needs of specific communities, rather than applied uniformly statewide.”
“This research underscores that combating antimicrobial resistance is not just a medical challenge, but a social one,” said David van Duin, MD, PhD, professor of medicine and founding director of UNC Health’s Immunocompromised Host ID service. “Policies must integrate equity into AMR strategies to ensure vulnerable populations are not left behind.”
Funded in part by Merck Sharp & Dohme LLC, the study was conducted using UNC Health’s electronic health records and North Carolina State Vital Records. It followed patients for 30‑day all‑cause mortality after Enterobacterales culture growth.
Publication
The full study, “Neighborhood deprivation, antimicrobial resistance, and mortality in patients with Enterobacterales: A retrospective cohort study, is available open access in CMI (Clinical Microbiology and Infectious) Communications.