Bacterial-resistant infections in resource-limited countries

Considering that antibiotics play a crucial role in reducing morbidity and mortality due to bacterial infections, antibiotic resistance is a major problem in resource-limited countries (RLCs) where there is a high burden of infectious diseases, resistance rates are even higher than in industrialized countries, and therapeutical options are often unavailable or too expensive. Multidrug-resistant organisms - e.g. Streptococcus pneumoniae, Salmonella Typhi, Shigella spp., Neisseria gonorrhoeae, Mycobacterium tuberculosis - have been increasingly documented. Many factors contributing to antibiotic resistance in RLCs are strongly related to poverty: lack of knowledge or information of health-care professionals, lack of laboratory facilities, inadequate access to health system, lack of money available to pay for the appropriate amount of antibiotics, dispensation of drugs by untrained people, availability of substandard and counterfeit drugs, etc. Moreover, in RLCs, transmission of resistant bacteria is facilitated by person-to-person contact, through contaminated food, unsafe water or by vectors. An understanding of this complex and multifactorial scenario is crucial to develop any containment strategy based on the promotion of a correct use of antibiotics and infection control measures.