From the Guidelines
Yes, antimicrobial resistance (AMR) is more common in people with comorbidities or immunodeficiency, as these individuals often have impaired immune systems and are more frequently exposed to antibiotics, creating selective pressure that promotes the survival of resistant bacterial strains 1. Patients with conditions such as diabetes, chronic kidney disease, HIV/AIDS, cancer, or those on immunosuppressive medications face a higher risk of developing resistant infections.
The presence of comorbidities or immunodeficiency increases the risk of infection with multidrug-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci 1. Additionally, immunocompromised patients may have difficulty clearing even partially treated infections, allowing bacteria more time to develop resistance mechanisms.
Key factors that contribute to the increased risk of AMR in people with comorbidities or immunodeficiency include:
- Frequent antibiotic treatments
- Longer hospital stays
- Invasive procedures
- Impaired immune systems
- Repeated exposure to antibiotics, creating selective pressure that promotes the survival of resistant bacterial strains
For these high-risk populations, healthcare providers should consider more careful antibiotic stewardship, including:
- Appropriate culture collection before starting antibiotics
- Narrowing therapy based on susceptibility results
- Using the shortest effective duration of treatment
- Preventive measures like vaccinations, infection control practices, and early intervention for infections to reduce exposure to antimicrobials and subsequent development of resistance 1.
In critically ill patients, empiric antimicrobial therapy should be started as soon as possible, taking into account the pathophysiological status of the patient and the pharmacokinetic properties of the employed antibiotics 1. The choice of empiric antibiotic regimens should be based on the clinical condition of the patients, the individual risk for infection by resistant pathogens, and the local resistance epidemiology 1.
From the Research
Antimicrobial Resistance in People with Comorbidities or Immunodeficiency
- Antimicrobial resistance (AMR) is a growing concern worldwide, with studies indicating that it is more common in people with comorbidities or immunodeficiency 2, 3.
- Research has shown that patients with primary immunodeficiency disorders (PID) have a higher rate of antibiotic resistance compared to immunocompetent patients 2.
- A study published in 2015 found that antimicrobial susceptibilities of several organisms isolated from PID patients were significantly lower compared to that of immunocompetent patients 2.
- The use of long-term prophylactic antibiotics in primary immune deficiencies has been shown to be effective in preventing infections, but it also raises concerns about the development of resistant pathogens 3.
- The relationship between long-term antibiotic use and the prevalence of resistant pathogens in people with comorbidities or immunodeficiency requires further investigation 3.
Mechanisms of Antimicrobial Resistance
- The mechanisms of AMR are complex and involve the evolution of microorganisms to evade the effects of antimicrobials 4, 5.
- The overuse and misuse of antibiotics have accelerated the spread of antibiotic-resistant bacteria, making drug treatment ineffective 5.
- Understanding the resistance mechanisms of bacteria is a key step in the development of new antimicrobial drugs to tackle drug-resistant bacteria 5.
Prevalence of Antimicrobial Resistance
- At least 700,000 people worldwide die each year due to antimicrobial resistance (AMR), and this number could rise to 10 million by 2050 if new and better treatments are not developed 5.
- The World Health Organization (WHO) has published a list of pathogens that pose the greatest threat to humans, including those with the highest "priority status" 5.