Global antimicrobial-resistance drivers: an ecological country-level study at the human–animal interface

作者：Kasim Allel, Lucy Day, Alisa Hamilton, Leesa Lin, Luis Furuya‐Kanamori, Catrin E. Moore, Thomas P. Van Boeckel, Ramanan Laxminarayan, Laith Yakob · 发表于：The Lancet Planetary Health · 年份：2023 · DOI：10.1016/s2542-5196(23)00026-8 · 被引用次数：235 · 研究领域：Antibiotic Use and Resistance、Pharmaceutical and Antibiotic Environmental Impacts、Antibiotic Resistance in Bacteria

BACKGROUND: Antimicrobial resistance (AMR) is a pressing, holistic, and multisectoral challenge facing contemporary global health. In this study we assessed the associations between socioeconomic, anthropogenic, and environmental indicators and country-level rates of AMR in humans and food-producing animals. METHODS: In this modelling study, we obtained data on Carbapenem-resistant Acinetobacter baumanii and Pseudomonas aeruginosa, third generation cephalosporins-resistant Escherichia coli and Klebsiella pneumoniae, oxacillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium AMR in humans and food-producing animals from publicly available sources, including WHO, World Bank, and Center for Disease Dynamics Economics and Policy. AMR in food-producing animals presented a combined prevalence of AMR exposure in cattle, pigs, and chickens. We used multivariable β regression models to determine the adjusted association between human and food-producing animal AMR rates and an array of ecological country-level indicators. Human AMR rates were classified according to the WHO priority pathogens list and antibiotic-bacterium pairs. FINDINGS: Significant associations were identified between animal antimicrobial consumption and AMR in food-producing animals (OR 1·05 [95% CI 1·01-1·10]; p=0·013), and between human antimicrobial consumption and AMR specifically in WHO critical priority (1·06 [1·00-1·12]; p=0·035) and high priority (1·22 [1·09-1·37]; p<0·0001) path...