Resource-poor countries experience higher levels of antimicrobial resistance

October 12, 2016

Study reveals strong association between country income status and antimicrobial resistance prevalence

The first study to examine the association between national income and antimicrobial resistance (AMR) prevalence, conducted by CDDEP researchers and collaborators, found that AMR prevalence increases as national income decreases.  AMR levels are highest in the poorest countries, underscoring the urgent necessity of new policies to address AMR in resource-poor settings.

The study assessed the relationship between the level of AMR of the three most common pathogens causing infections in hospitals and the community, Escherichia coli, Klebsiella species, and Staphylococcus aureus, and the gross national income per capita (GNIPC) of 45 countries.

Countries were grouped by their GNIPC into high, upper-middle and lower-middle income economies and examined against 2013-2014 country-specific prevalence of third-generation cephalosporin (3GC) resistant E. coli, methicillin-resistant S. aureus (MRSA), and 3GC resistant Klebsiella species.

For 3GC resistant E. coli, the model predicted prevalence of 12 percent in high-income countries, 31 percent in upper-middle income countries and 78 percent in lower-middle income countries. The results were stronger for 3GC resistant E. coli and Klebsiella species than for MRSA.

According to Sumanth Gandra, scholar at the Center for Disease Dynamics, Economics & Policy and a study author, “The prevalence of antibiotic-resistant infections is much higher in resource poor countries. Poor environmental sanitation, poor infection control practices and lack of stewardship programs in healthcare facilities are the major contributors. We need to implement policies and programs to address AMR, particularly in resource-poor settings.”

In their analysis, researchers used ResistanceMap, a web-based collection of data visualization tools developed by CDDEP, featuring antibiotic consumption data from 75 countries and antibiotic resistance data from 49 countries.

The study in the International Journal of Infectious Diseases is available here:

ResistanceMap, the interactive tool based on country-specific resistance data, is available here:


About the Center for Disease Dynamics, Economics & Policy 
The Center for Disease Dynamics, Economics & Policy (CDDEP) produces independent, multidisciplinary research to advance the health and wellbeing of human populations around the world.  CDDEP projects are global in scope, spanning Africa, Asia, and North America and include scientific studies and policy engagement.  The CDDEP team is experienced in addressing country-specific and regional issues, as well as the local and global aspects of global challenges, such as antibiotic resistance and pandemic influenza. CDDEP research is notable for innovative approaches to design and analysis, which are shared widely through publications, presentations and web-based programs.  CDDEP has offices in Washington, D.C. and New Delhi and relies on a distinguished team of scientists, public health experts and economists.

Authors: Sumanth Gandra, Gerardo Alvarez-Uria, Ramanan Laxminarayan


12 Oct 2016