All ETDs from UAB

Advisory Committee Chair

Sadeep Shrestha

Advisory Committee Members

Megan Amerson-Brown

Rachael A Lee

Document Type


Date of Award


Degree Name by School

Master of Science in Public Health (MSPH) School of Public Health


Background: In the Southern and Appalachian regions of the United States, antibiotic prescription rates surpass the national average, coinciding with a higher prevalence of Type II diabetes (DM2). Although international research has previously described the correlation between DM2 and increased risk of antimicrobial-resistant (AMR) infections, comprehensive studies on this relationship are lacking in the U.S. The objective of this study was to investigate the association between AMR infections and DM2 and examine the association in two DM2 positive racial groups. This study also examined the differences in the prevalence of clindamycin resistance of methicillinresistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) isolated from DM2 patients. Method: This retrospective case control study utilized electronic medical record systems (EMRs) data from the University of Alabama Birmingham (UAB) Informatics for Integrating Biology and the Bedside program from 2013-2019. Inpatients with confirmed bacterial infections recorded in EMRs and microbiology culture samples collected during hospitalization were included. Antimicrobial categories were established for individual bacteria based on 1st line therapeutic agents (Table 1). For this study, AMR, defined as non-susceptibility to at least one antimicrobial agent in one or more antimicrobial categories, was examined through log binomial regression and multivariable logistic regression models. Result: Of 3,339 bacterial isolates, 2,287 (68.5%) were included. In the inpatient setting, DM2 patients with Gram-negative rod (GNR) infections had 3.6 times increased odds of AMR compared to non-DM2 patients. DM2 patients with S. aureus (Gram-positive cocci [GPC]) infections had 4.0 times increased odds of AMR and 7.0 times increased odds of having MRSA compared to non-DM2 patients. DM2 African American (AA) patients with GNR infections had 7.4 times increased odds of AMR compared to DM2 White patients. Similarly, DM2 AA patients with GPC infections had 2.3 times increased odds of having MRSA infections compared to DM2 White patients. Notably, 47.2% of the total MRSA isolates identified in DM2 patients were resistant to clindamycin, compared to MSSA (26.8%). Conclusion: In the inpatient setting, DM2 increases the risk of AMR and MRSA. These findings highlight the importance of DM2 management and prevention to mitigate the escalating threat of bacterial resistance to antimicrobials.

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