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Reducing antibiotic consumption alone may not be enough to curb resistance

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September 14, 2018

Controlling antimicrobial resistance may require interventions in addition to reducing antibiotic consumption, according to findings published in The Lancet Planetary Health.

“Most research on antimicrobial resistance has focused on data-rich, high-income countries,” Peter Collignon, PhD, executive director of ACT Pathology at Canberra Hospital and professor at the Australian National University Medical School, and colleagues wrote. “However, the quality of the physical infrastructure and health systems in high-income countries has converged to such an extent that there is insufficient contrast in data to identify easily how variations in social, physical, and economic environments affect antimicrobial resistance.”

Collecting data from the IQVIA MIDAS database, ResistanceMap, the WHO 2014 report on antimicrobial resistance and contemporary publications, Collignon and colleagues created two global indices tracking Escherichia coli resistance and aggregate resistance.

E . coli resistance is defined as the global average prevalence of E. coli bacteria resistant to third-generation cephalosporins and fluoroquinolones. Aggregate resistance is defined as the combined average prevalence of Staphylococcus aureus bacteria resistant to methicillin and E. coli and Klebsiella species bacteria resistant to third-generation cephalosporins, fluoroquinolones and carbapenems.

Along with antimicrobial resistance data for 103 countries from 2008 to 2014, researchers obtained governance, education, gross domestic product (GDP) per capita, health care spending and community infrastructure data from the World Bank Databank to investigate associations between antimicrobial resistance and other potential contributing factors.

According to the study, both antimicrobial resistance indices were inversely correlated with GDP per capita, education, infrastructure, public health care spending and antibiotic consumption. However, Collignon and colleagues observed a positive correlation between the two antimicrobial resistance indices and higher temperatures, poorer governance and the ratio of private to public health expenditure.

When the researchers analyzed antibiotic consumption data — available for only 73 of the 103 countries — better infrastructure (P = .014 and P = .0052) and better governance (P = .025 and P < .0001) were associated with lower antimicrobial resistance indices. Moreover, antibiotic consumption and the two antimicrobial resistance indices were not significantly associated (P = .64 and P = .070).

E coli and aggregate resistance had a mean prevalence of 29.4% (standard deviation [SD] = 18.7) and 29.6% (SD = 15), respectively.

Collignon and colleagues said that contagion, or the “spread of resistant strains and resistance genes,” is a dominant contributing factor to antimicrobial resistance. To reduce the global burden of antimicrobial resistance, it is imperative to improve sanitation, governance and the regulation of the private health sector. Increased health care expenditure and access to clean water is also critical, according to the study.

“In developed countries, where the focus has been on antibiotic consumption as the most identifiable factor contributing to antimicrobial resistance, we showed that consumption explains only a portion of the observed antimicrobial resistance levels,” Collignon and colleagues wrote. “Moreover, intervention measures to decrease antibiotic consumption alone are not likely to be sufficient, especially in low-income and middle-income countries, because contagion is probably the main factor affecting antimicrobial resistance levels.” – by Marley Ghizzone

Disclosures: Collignon reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.