Unveiling the sex-specific impact on antimicrobial resistance (AMR): A Bayesian hierarchical model approach using Vivli data

Gender is vital to AMR research and stewardship, as many factors contributing to AMR also vary by gender. These include rates at which different antibiotics are prescribed, bacterial colonisation rates, infection rates as well as patterns of contact and health-seeking behaviours. Despite gender’s therefore clear interaction with AMR, it is currently rarely included in analyses. All National Action Plans should consider gender (WHO), and we need data disaggregated by sex in order to inform such action plans. Our group has previously shown a higher level of resistance in men. We aim to use the Vivli AMR platform as a basis for studying AMR by gender, as many of the datasets have the sex linked to the sample, and how these datasets interact with other gender-related indicators. Initially we will identify gender patterns by country, and subsequently run a multivariate analysis to identify what causes these patterns, and the pathways to resistance. We will include indicators from the World Bank, including C-section rates, gender workforce statistics, education statistics and age at first childbirth. This will also lead us to analyse interventions on the basis of this research. This work will help inform public health practices and strengthen the evidence base for AMR-targeted interventions, by deepening our understanding of the pathways to AMR, and identifying subsets of the population that are at particular risk. Combining the vast global AMR data that is available through the Vivli datasets with other global indicators is a novel approach to using open data to address the complexities of AMR and the current priority that is understanding how to structure AMR control by gender. It paves the way for the use of such data in other global projects targeted at understanding the pathways to AMR, as well as encouraging existing programmes to collect and report more gender-disaggregated data.