I have posted before about the “postcode lottery” and it’s influence on rates of MRSA, affecting deprived postcodes (or zipcodes!) more than others. But this issue is wider than regional influence. On an international scale, your changes of a bad outcome from infectious disease varies, sometimes wildly, by where you happen to be in the world. A new article in CID on clinical outcomes from carbapenem-resistant Acinetobacter baumannii infections bears this out.

This international study of clinical outcomes from carbapenem-resistant A. baumannii infections (defined by a clinical rather than screening culture) found that 30 day mortality was 6% in Australia/Singapore, 25% in the USA, and 49% in South-Central America. The sample size wasn’t huge (a total of 842 cases), and other factors were at play (having a BSI and co-morbidities were, unsurprisingly, independently associated with mortality). But it does illustrate powerfully international differences in infection-related outcomes. Country-level differences in infection outcomes have been observed with a range of organisms including SARS-CoV-2, Candida auris, and S. aureus bacteraemia. And we know that rates of healthcare-associated infection in general vary considerably around the world.

When you think about the huge differences in the resourcing and set-up of healthcare around the world, this is no surprise. If you work in an underfunded healthcare system, then it’s not going to be possible to achieve the same clinical outcomes in general and in relation to infection.

This introduces an important concept. Looking at clinical outcomes due to healthcare-associated infection on the other side of the world to determine IPC policy locally may not always be wise. For example, looking at Candida auris clinical outcomes from a resource limited setting may not be helpful in deciding how to balance the risk of C. auris prevention vs. interruption of healthcare provision in a different setting. On the other hand, we can’t always wait until we have complete local data before deciding how to manage an emerging threat. So, a merger between making best use of international datasets combined with local intelligence is likely to result in the best management strategy.