Antimicrobial resistance (AMR) poses an increasing threat to patients in the U.S. and even more so in rural communities, driven by factors that are distinct to rural settings, including clinical workforce shortages and inequitable distribution, economic pressures and hospital closures, and environmental exposures, according to a new white paper from the AMR Action Fund.
Drawing on real-world case studies, interviews with clinicians and professors, peer-reviewed research, and data from national health agencies, the white paper, “Underserved and Overexposed: AMR in Rural America,” examines the risks AMR poses to a variety of populations, including pediatric patients, expectant and birthing mothers, and farm workers. The paper highlights the challenges that rural hospitals face when it comes to adhering to antibiotic stewardship principles and examines how agricultural workers can be exposed occupationally to antibiotics and antifungal compounds, putting them and their household members at an increased risk of drug-resistant infections.
“Rural health systems represent some of the most resource-constrained environments in the country,” said AMR Action Fund CEO Henry Skinner, PhD. “As drug-resistant infections continue to rise globally and nationally, patients and clinicians in rural America face an array of complex and interconnected challenges. Addressing these urgent challenges will require cross-sector collaboration — from policymakers, medical societies, and industry alike.”
Rural health systems are under strain throughout the U.S., with research showing that approximately 80 percent of U.S. counties lack an infectious disease physician, and two-thirds of federally designated primary care shortage areas are rural. The report warns that this scarcity undermines the ability to diagnose and treat infections properly, a key defense against AMR. Moreover, cost pressures and limited diagnostic capacity often drive rural providers to rely on older, broad-spectrum antibiotics, drugs that may be less effective and can contribute to antibiotic resistance in the long run.
In addition to characterizing the threat AMR poses to rural populations, the paper offers several recommendations to mitigate the risk of AMR and improve patient care, including enhancing recruitment efforts for clinicians to work in rural settings, improving access to and utilization of new diagnostic and antimicrobial technologies and therapeutics, and increasing support for antimicrobial stewardship programs in rural settings.
“Safeguarding rural communities against antimicrobial resistance is integral to maintaining national health security and economic resilience,” said Jonathan Daniels, director of U.S policy at the AMR Action Fund. “The findings in this paper reinforce the urgent need for investment — not only in innovation, but in equitable delivery systems that ensure these tools reach every community.”
Download a PDF of the paper here: Underserved and Overexposed: AMR in Rural America.