Peter Collignon|John J. Beggs|Timothy R. Walsh|Sumanth Gandra|Ramanan Laxminarayan
Anthropological and socioeconomic factors contributing to global antimicrobial resistance: a univariate and multivariable analysis
Canberra Hospital|Australian National University|Cardiff University|Center for Disease Dynamics, Economics & Policy|Center for Disease Dynamics, Economics and Policy
backgroundunderstanding factors driving global antimicrobial resistance limited analysed antimicrobial resistance antibiotic consumption worldwide versus many potential contributing factorsmethodsusing three sources data resistancemap 2014 report antimicrobial resistance contemporary publications created two global indices antimicrobial resistance 103 countries using data 2008 2014 escherichia coli resistancethe global average prevalence e coli bacteria resistant thirdgeneration cephalosporins fluoroquinolones aggregate resistancethe combined average prevalence e coli klebsiella spp resistant thirdgeneration cephalosporins fluoroquinolones carbapenems meticillinresistant staphylococcus aureus antibiotic consumption data obtained iqvia midas database world bank databank used obtain data governance education gross domestic product gdp per capita healthcare spending community infrastructure eg sanitation corruption index derived using data transparency international examined associations antimicrobial resistance potential contributing factors using simple correlation univariate analysis logistic regression model multivariable analysisfindingsin univariate analysis gdp per capita education infrastructure public healthcare spending antibiotic consumption inversely correlated two antimicrobial resistance indices whereas higher temperatures poorer governance ratio private public health expenditure positively correlated multivariable regression analysis confined 73 countries antibiotic consumption data available considering effect changes indices e coli resistance r2 054 aggregate resistance r2 075 better infrastructure p0014 p00052 better governance p0025 p00001 associated lower antimicrobial resistance indices antibiotic consumption significantly associated either antimicrobial resistance index multivariable analysis p064 p0070interpretationreduction antibiotic consumption sufficient control antimicrobial resistance contagionthe spread resistant strains resistance genesseems dominant contributing factor improving sanitation increasing access clean water ensuring good governance well increasing public healthcare expenditure better regulating private health sector necessary reduce global antimicrobial resistancefundingnone