Background Growing evidence indicates antimicrobial resistance disproportionately affects individuals living in socially vulnerable areas. This study evaluated the association between Streptococcus pneumoniae (SP) antimicrobial resistance (AMR) and the CDC/ATSDR Social Vulnerability Index (SVI) in the United States. Methods Adult patients ≥ 18 years with 30-day nonduplicate SP isolates from ambulatory/hospital settings from January 2011–December 2022 with zip codes of residence were evaluated across 177 facilities in the BD Insights Research Database. Isolates were identified as SP AMR if they were non-susceptible to ≥ 1 antibiotic class (macrolide, tetracycline, extended-spectrum cephalosporins, or penicillin). Associations between SP AMR and SVI score (overall and themes) were evaluated using generalized estimating equations with repeated measurements within county to account for within-cluster correlations. Results Of 8,008 unique SP isolates from 574 US counties across 39 states, the overall proportion of AMR was 49.9%. A significant association between socioeconomic status (SES) theme and SP AMR was detected with higher SES theme SVI score (indicating greater social vulnerability) associated with greater risk of AMR. On average, a decile increase of SES, indicating greater vulnerability, was associated with a 1.28% increased risk of AMR (95% confidence interval [CI], 0.61%, 1.95%; P=0.0002). A decile increase of household characteristic score was associated with a 0.81% increased risk in SP AMR (95% CI,0.13%, 1.49%; P=0.0197). There was no association between racial/ethnic minority status, housing type and transportation theme, or overall SVI score and SP AMR. Conclusions SES and household characteristics were the SVI themes most associated with SP AMR.

中文翻译：

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美国成人社会脆弱性与肺炎链球菌耐药性之间的关联

背景 越来越多的证据表明，抗菌素耐药性对生活在社会弱势地区的个人造成了不成比例的影响。本研究评估了美国肺炎链球菌 (SP) 抗菌素耐药性 (AMR) 与 CDC/ATSDR 社会脆弱性指数 (SVI) 之间的关联。方法 对 BD Insights 研究数据库中 177 个机构的 2011 年 1 月至 2022 年 12 月期间来自门诊/医院且居住邮政编码的 30 天非重复 SP 分离株的 18 岁以上成年患者进行了评估。如果分离株对 ≥ 1 类抗生素（大环内酯类、四环素、广谱头孢菌素或青霉素）不敏感，则被鉴定为 SP AMR。SP AMR 和 SVI 评分（总体和主题）之间的关联使用广义估计方程进行评估，并在县内进行重复测量，以解释集群内的相关性。结果 在来自美国 39 个州 574 个县的 8,008 个独特 SP 分离株中，AMR 的总体比例为 49.9%。社会经济地位 (SES) 主题与 SP AMR 之间存在显着关联，SES 主题 SVI 评分越高（表明社会脆弱性越高），AMR 风险越大。平均而言，SES 的十分之一增加（表明脆弱性更大）与 AMR 风险增加 1.28% 相关（95% 置信区间 [CI]，0.61%、1.95%；P=0.0002）。家庭特征得分的十分之一增加与 SP AMR 风险增加 0.81% 相关（95% CI，0.13%，1.49%；P=0.0197）。少数种族/族裔状况、住房类型和交通主题或总体 SVI 得分和 SP AMR 之间没有关联。结论 SES 和家庭特征是与 SP AMR 最相关的 SVI 主题。