Prisons face higher rates of drug-resistant bacteria

Antimicrobial resistance (AMR) — when bacteria stop responding to the drugs designed to kill them — is a growing global health threat. People who live in, move through, or otherwise have contact with the criminal justice system can be especially vulnerable to infectious diseases because of crowded living conditions, complex health needs, and other social factors. To understand the scale of the problem, researchers led by Clare Oliver‐Williams carried out a rapid systematic scoping review that collected and summarized existing studies on bacterial AMR and antibiotic use in this population. The review was registered and made available on OSF (https://doi.org/10.17605/OSF.IO/XHCFJ) and looked for research published from 1 January 2010 to 28 September 2023. The team searched Embase, Medline, and Scopus for relevant papers. One author screened all records, with 10% of records checked by a second reviewer, and studies were included if they reported on antimicrobial resistance or patterns of antibiotic use among people in contact with the criminal justice system. The aim was to map what is known and where the evidence is thin or missing.

The review identified 16 papers that met the inclusion criteria. Study quality was assessed using the Newcastle-Ottawa Scale and the STROBE AMS checklist, and eight of the 16 papers were judged to be at lower risk of bias. Three studies focused on antibiotic use: one reported common inappropriate prescribing, and two found associations between recent antibiotic use and resistant infections. Fourteen papers reported findings on resistant bacteria, with many papers focusing on Mycobacterium tuberculosis and Staphylococcus aureus. In studies of tuberculosis within prison populations, reported levels of drug-resistant TB ranged from 5.2% to 37% (n=4). Studies that looked at methicillin-resistant Staphylococcus aureus (MRSA) found colonization rates between 8.1% and 8.8% (n=4). Other bacteria reported in the included papers included Salmonella spp., Acinetobacter spp., Group A Streptococcus, and Mycoplasma genitalium. The reviewers synthesized these findings in narrative form to summarize patterns and gaps in the literature.

Taken together, the evidence summarized by Clare Oliver‐Williams indicates that people in contact with the criminal justice system face heightened risks of resistant bacterial infections. Yet the review also highlights a striking lack of studies on antibiotic use in these settings: only three studies addressed prescribing or recent antibiotic exposure, limiting our understanding of how prescribing practices may drive resistance. This gap matters because interventions to reduce AMR often rely on both better infection control and smarter antibiotic use. The authors conclude that addressing AMR in people who are incarcerated or otherwise involved with the criminal justice system will require collaborative, targeted public health interventions. They point to the need for improved surveillance, more studies of antibiotic prescribing and use, and coordinated action between health services and justice systems to reduce the burden of resistant infections.