Exploring the intersection of racism, antimicrobial resistance, and vaccine equity

Abdul‐Mutakabbir, Jacinda C.; Simiyu, Brenda

doi:10.1017/ash.2022.283

Cited by 5 publications

(3 citation statements)

References 43 publications

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“…Although most AS interventions include quality improvement (QI) components focused on optimizing antimicrobial prescribing, there remains a significant gap in the integration of variables that measure health-related social needs inequities and areas for intervention. 11 Reimagining AS through an equity lens, as described by Cichon et al, involves enhancing access to AS, reducing prescribing disparities, launching targeted public health campaigns, and ensuring representation in decision-making. 18 Globally and nationally, healthcare governing agencies such as the World Health Organization (WHO) and the CDC have declared health an essential human right.…”

Section: Overview Of Antimicrobial Stewardship-associated Inequitiesmentioning

confidence: 99%

“…6,7 Furthermore, multiple authors also report disparities in microbial diagnoses and the appropriateness of the antimicrobials prescribed to minoritized individuals. [8][9][10][11] The confluence of multiple, overlapping systems of oppression (including, but not limited to racism, homophobia, and ableism) impacting healthrelated social needs (e.g., education, employment, access to health services, etc.) have been attributed as root causes of the reported inequities.…”

Section: Introductionmentioning

confidence: 99%

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Prioritizing Equity in Antimicrobial Stewardship Efforts (EASE): a framework for infectious diseases clinicians

Abdul-Mutakabbir,

Tan,

Johnson

et al. 2024

ASHE

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Health equity gaps persist across minoritized groups due to systems of oppression affecting health-related social needs such as access to transportation, education and literacy, or food and housing security. Consequently, disparities in the prevalence of multidrug-resistant infections, infectious disease outcomes, and inappropriate antimicrobial use have been reported across minoritized populations. The Joint Commission and Centers for Medicare and Medicaid Services (CMS) have formally acknowledged the importance of integrating health equity-focused initiatives into existing hospital quality improvement (QI) programs. Here, we review documented disparities in antimicrobial stewardship and offer a framework, derived from components of existing health equity and QI tools, to guide clinicians in prioritizing equity in antimicrobial stewardship efforts (EASE).

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Section: Overview Of Antimicrobial Stewardship-associated Inequitiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prioritizing Equity in Antimicrobial Stewardship Efforts (EASE): a framework for infectious diseases clinicians

Abdul-Mutakabbir,

Tan,

Johnson

et al. 2024

ASHE

Self Cite

View full text Add to dashboard Cite

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“…1 In accordance with the DJ principle of intersectionality, we recommend incorporating demographic data related to disability status as well as other social identity factors, such as race and class, that shape how people's disabilities are interpreted and what explicit or implicit biases they may face in health care systems. 27,28,29,30 Given well-documented inequities in myriad health care settings where antibiotics are prescribed, we can expect these inequities to manifest in antibiotic prescribing practices. 31 Since inequitable care may show up as both under-and overprescribing, data tracking and analysis processes must incorporate data on the health care side (prescription and prescriber details, diagnostic workup, and treatment outcomes), as well as on the patient side (disability status and other sociodemographic details).…”

Section: Stewardship Recommendationsmentioning

confidence: 99%

What Does Disability Justice Require of Antimicrobial Stewardship?

2024

AMA Journal of Ethics

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This commentary on a case argues that antimicrobial stewardship requires an intersectional disability justice approach if it is to be equitable, particularly for multiply marginalized patients with disabilities residing in nursing homes, who are more susceptible to antibiotic underand overtreatment. Disability justice concepts emphasize resistance to structural and capitalist roots of ableism and prioritize leadership by disabled persons. A disability justice perspective on antimicrobial stewardship means prioritizing clarification of presumptive diagnoses of infection in vulnerable patients, clinician education led by disabled persons, and data collection. CaseDr S is a resident physician responsible for admitting patients overnight. A patient, M, is being transferred from a nursing home (NH) for tachycardia and hypotension. The NH's physician, Dr P, started M on a broad-spectrum antibiotic prior to M's transfer. Dr S notices in M's record that M has had multiple episodes of being treated with antibiotics in-hospital or in the NH, but with no specific infection diagnosis. Dr S worries about exacerbating this pattern of possible excessive antibiotic use that might expose M to unnecessary toxicity and threat of antibiotic resistance. Dr S plans to be judicious with antibiotics when treating M. M arrives on the unit and is now under Dr S's care. M is 57 years old with a history of cardiac arrest resulting in anoxic brain injury. M has a tracheostomy and normally breathes on her own without a ventilator; however, for transport from the NH to the hospital, she has been connected to a ventilator. M turns her head to look at Dr S when Dr S speaks to M, but M cannot speak while connected to the ventilator, appears to Dr S to be uncomfortable, and does not reliably signal "yes" or "no" in response to Dr S's questions. Now that Dr S has met M, Dr S questions her initial instinct to limit antibiotics for M. CommentaryUp to 70% of NH residents are prescribed antibiotics over the course of a year, and 40% to 75% of such prescriptions may be inappropriate or unnecessary. 1 Many residents live

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Treating Mycoplasma genitalium (in pregnancy): a social and reproductive justice concern

McKnight,

Farsides,

Soni

et al. 2024

Monash Bioeth. Rev.

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Antimicrobial Resistance is a threat to individual and to population health and to future generations, requiring “collective sacrifices” in order to preserve antibiotic efficacy. ‘Who should make the sacrifices?’ and ‘Who will most likely make them?’ are ethical concerns posited as potentially manageable through Antimicrobial Stewardship. Antimicrobial stewardship almost inevitably involves a form of clinical cost-benefit analysis that assesses the possible effects of antibiotics to treat a diagnosed infection in a particular patient. However, this process rarely accounts properly for patients – above and beyond assessments of potential (non)compliance or adherence to care regimes. Drawing on a vignette of a pregnant woman of colour and migrant diagnosed with Mycoplasma genitalium, a sexually transmissible bacterium, this article draws out some of the ethical, speculative, and practical tensions and complexities involved in Antimicrobial Stewardship. We argue that patients also engage in a form of cost-benefit analysis influenced by experiences of reproductive and social (in)justice and comprising speculative variables - to anticipate future possibilities. These processes have the potential to have effects above and beyond the specific infection antimicrobial stewardship was activated to address. We contend that efforts to practice and research antimicrobial stewardship should accommodate and incorporate these variables and acknowledge the structures they emerge with(in), even if their components remain unknown. This would involve recognising that antimicrobial stewardship is intricately connected to other social justice issues such as immigration policy, economic justice, access to appropriate medical care, racism, etc.

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Exploring the intersection of racism, antimicrobial resistance, and vaccine equity

Cited by 5 publications

References 43 publications

Prioritizing Equity in Antimicrobial Stewardship Efforts (EASE): a framework for infectious diseases clinicians

Prioritizing Equity in Antimicrobial Stewardship Efforts (EASE): a framework for infectious diseases clinicians

What Does Disability Justice Require of Antimicrobial Stewardship?

Treating Mycoplasma genitalium (in pregnancy): a social and reproductive justice concern

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