If you are a man and have encountered a nasty Escherichia coli infection, you should have a few more worries. Because a study published in Plos Medicine and presented by the group coordinated by Gwen Knight of the London School of Hygiene and Tropical Medicine at the European Congress of Clinical Microbiology and Infectious Diseases, in Barcelona from 27 to 30 April, found a correlation between sex and resistance to antibiotics precisely for this bacterium: which therefore more frequently shows resistance in male patients than in females.
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A threat about which little is known
Antibiotic resistance (AMR) represents a serious threat to global public health: according to the WHO, in 2019 it was directly responsible for 1.27 million deaths globally, contributing indirectly to another 4.95 million deaths worldwide. In addition to death and disability, the World Bank adds, resistant infections burden the health systems of all countries, with additional costs exceeding 1 trillion dollars by 2050 and a loss of more than 3 trillion dollars in GDP each year by 2030.
Yet, write the authors led by Knight, too little is known about the way in which the prevalence of resistance varies not only according to sex, but also with age and geographical area of origin. What is known, for example, is that the incidence of bacterial infections increases with age: the greater frequency of infections among the elderly translates into greater exposure to antibiotics and greater contact with healthcare facilities, such as hospitals, which are known to be a place for transmission of resistant bacteria. But this association does not always appear linearly. The relationship between sex and AMR is also not so clear, although most antibiotic resistance surveillance systems, both in Europe and the United States, collect disaggregated data for this variable, but not in a comprehensive way.
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I study
So the researchers decided to tackle the issue head on, analyzing surveillance data relating to infections reported to the European Antimicrobial Resistance Surveillance Network (EARS-Net), for a total of almost seven million reports from 944 thousand people in period 2015-2019. The database, in addition to containing information on the sensitivity of 38 bacterial species to different antibiotics, also reported data on age (from 1 to 100 years), sex and geographical location, for a total of 29 European countries. Understanding the association between these different variables – the researchers argue – can help to better understand the epidemiology of antibiotic resistance, make predictions on its evolution and help health authorities to define targeted interventions.
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The differences emerged
The results of the analysis show some trend lines. Firstly, it emerges that only 47% of the results came from female individuals, with a similar age distribution in both sexes (66 years on average). Secondly, it seems quite clear that there are substantial variations in the prevalence of antibiotic resistance based on age both between different countries and within the same country. As regards the sex variable, it emerges that men were more likely to have a resistant infection, compared to women, in the case of Escherichia coli and Klebsiella pneumoniae, and among younger people for Acinetobacter. For methicillin-resistant Staphylococcus aureus, the researchers then observed a clear increase in the prevalence of resistance based on age (in 72% of the countries examined, an increase in resistance was found among younger and older men), while for Pseudomonas aeruginosa, resistance to various antibiotics peaked around the age of 30. “The differences in the incidence of antimicrobial resistance based on age and sex – the researchers write – can be explained by cultural differences between the countries examined, but also by the typical methods of infection of the different species of bacteria”.
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The surprise of the researchers
The fact that infections due to bacteria resistant to antibiotics have a greater prevalence in men, underlines the author, is however surprising: because women have more risk factors – for example childbirth – and in general a greater incidence of infections of the urinary tract and consequently increased exposure to antibiotics. And yet, the researchers conclude, we must not forget that some of these trends observed in the study could be due to differences in the guidelines on the use of antibiotics adopted by the countries examined. A good reason to proceed with harmonization at European level.
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– 2024-05-02 11:11:33
