Abstract
BackgroundThe rapid increase of bacterial antibiotic resistance could soon render our most effective method to address infections obsolete. Factors influencing pathogen resistance prevalence in human populations remain poorly described, though temperature is known to contribute to mechanisms of spread.AimTo quantify the role of temperature, spatially and temporally, as a mechanistic modulator of transmission of antibiotic resistant microbes.MethodsAn ecologic analysis was performed on country-level antibiotic resistance prevalence in three common bacterial pathogens across 28 European countries, collectively representing over 4 million tested isolates. Associations of minimum temperature and other predictors with change in antibiotic resistance rates over 17 years (2000–2016) were evaluated with multivariable models. The effects of predictors on the antibiotic resistance rate change across geographies were quantified.ResultsDuring 2000–2016, for Escherichia coli and Klebsiella pneumoniae, European countries with 10°C warmer ambient minimum temperatures compared to others, experienced more rapid resistance increases across all antibiotic classes. Increases ranged between 0.33%/year (95% CI: 0.2 to 0.5) and 1.2%/year (95% CI: 0.4 to 1.9), even after accounting for recognised resistance drivers including antibiotic consumption and population density. For Staphylococcus aureus a decreasing relationship of −0.4%/year (95% CI: −0.7 to 0.0) was found for meticillin resistance, reflecting widespread declines in meticillin-resistant S. aureus across Europe over the study period.ConclusionWe found evidence of a long-term effect of ambient minimum temperature on antibiotic resistance rate increases in Europe. Ambient temperature might considerably influence antibiotic resistance growth rates, and explain geographic differences observed in cross-sectional studies. Rising temperatures globally may hasten resistance spread, complicating mitigation efforts.
Highlights
For almost a century, antibiotics have been our most effective way to treat bacterial infections, and antibiotics underpin enormous population health gains
Antibiotic resistance in E. coli and K. pneumoniae has increased over time for most countries in Europe (Supplementary Figures S1, S2), while S. aureus resistance to meticillin has generally decreased over time (Figure S3)
While our findings should not be generalised to other bacterial pathogens and antibiotic classes without further analysis, they may help understand the currently observed geographic distribution of antibiotic resistance prevalence in Europe, which shows warmer areas experiencing higher levels of antibiotic resistance
Summary
Antibiotics have been our most effective way to treat bacterial infections, and antibiotics underpin enormous population health gains. Antibiotic resistance poses one of the world’s greatest public health threats today, with the potential to render many existing classes of antibiotics ineffective in the near future [3,4]. To address this crisis, numerous national and international bodies have begun developing policy to control antibiotic use and funding research aimed at identifying and targeting drivers of resistance [3,5]. The rapid increase of bacterial antibiotic resistance could soon render our most effective method to address infections obsolete. Conclusion: We found evidence of a long-term effect of ambient minimum temperature on antibiotic resistance rate increases in Europe. Rising temperatures globally may hasten resistance spread, complicating mitigation efforts
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