Understanding the Syndemic Interplay Between Noncommunicable Chronic Diseases and Multidrug Resistant Infections

Jacinda Abdul-Mutakabbir, PharmD, MPH, assistant professor of Clinical Pharmacy and antimicrobial resistance researcher at the University of California San Diego, was reviewing HIV manuscripts when she first became aware of the use of syndemics. It was there that she began to think about multidrug resistant (MDR) infections and if she could apply this synergistic approach.

“One thing that the syndemic approach states is that there has to be evidence of a synergistic and bidirectional relationship between the diseases,” Abdul-Mutakabbir said. “And then it made me think about the fact that so often we have patients that have antimicrobial resistant infections, and more often than not, they have a noncommunicable disease (NCD).”

In her further examination, working alongside her PhD candidate, found clinical data for isolates that were carbapenem resistant. When they studied the clinical characteristics, all of the patients had at least 1 comorbid disease, with diabetes being the most prevalent. Additionally, she saw that people with multidrug resistant tuberculosis were more susceptible to COPD.

The further she delved into the subject, the more she discovered that other researchers and clinicians were finding syndemic relationships between NCD and MDR infections. This became the basis for her study, which was recently published in the journal Infectious Diseases and Therapy.

Abdul-Mutakabbir explains the direct and indirect impacts and how noncommunicable diseases can impact MDR infections and vice versa.

“When I think about diabetes and just the hyperglycemic disease state, hyperglycemia can decrease our innate immunity…So when we think about diabetes, a macrovascular complication of diabetes is neuropathy that individuals can experience and can lead to diabetic foot infections. MRSA is often characterized in diabetic foot infections, and we're starting to see coinfections with other multidrug resistant organisms. And when we think about these complications and when they worsen or they get really bad, especially with cancer, we see patients are immunocompromised, which can lead to a hospitalization. So now, we have exposure to hospital-acquired resistant organisms.”

On the indirect side, she uses the example of patients with gram-negative infections and how lipopolysaccharide (LPS) can affects glycemic levels. 

“When we think about these infections, and we have pathways like gram-negative bacteria that have LPS, that LPS can then impact our glycemic stores and how hyperglycemia presents itself,” she said.

This is part 1 of a 2-part interview. In the next episode, Abdul-Mutakabbir explains how social determinants of health contribute to the syndemic relationship between NCDs and multidrug resistant infections as well as what clinicians and public health officials can consider in this area when thinking about patient management.