Global antimicrobial-resistance drivers: an ecological country-level study at the human-animal interface
Global antimicrobial-resistance drivers: an ecological country-level study at the human-animal interface
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DOI：
10.1016/s2542-5196(23)00026-8
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发表时间：
2023-04-01
影响因子：
25.7
通讯作者：
Yakob, Laith
中科院分区：
文献类型：
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作者：
Allel, Kasim;Day, Lucy;Yakob, Laith
抗微生物药物耐药性（AMR）是当代全球卫生面临的紧迫、全面和多部门挑战。在这项研究中，我们评估了社会经济、人为和环境指标与国家一级人类和食用动物抗菌素耐药性发生率之间的关系。方法在这项建模研究中，我们从公开来源获得了人类和食品生产动物中耐碳青霉烯不动杆菌鲍曼和铜绿假单胞菌，第三代耐头孢菌素大肠杆菌和肺炎克雷伯菌，耐oxacillin金黄色葡萄球菌和耐万古霉素屎肠球菌AMR的数据，包括世卫组织，世界银行和疾病动力学经济与政策中心。食用动物的抗菌素耐药性在牛、猪和鸡中呈现出抗菌素耐药性暴露的综合流行。我们使用多变量beta回归模型来确定人类和食用动物AMR率与一系列生态国家级指标之间的调整相关性。根据世卫组织重点病原体清单和抗生素-细菌对，对人类抗菌素耐药性进行分类。研究发现，食用动物抗菌药物用量与AMR之间存在显著相关性（OR 1中心点05 [95% CI 1中心点01-1中心点10]；p=0中心点013），人类抗菌药物用量与AMR之间存在显著相关性，特别是在WHO关键优先级（1中心点06[1中心点00-1中心点12]；p=0中心点035）和高优先级(1中心点22[1中心点09-1中心点37]；p
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 beta 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 foodproducing animals (OR 1 center dot 05 [95% CI 1 center dot 01-1 center dot 10]; p=0 center dot 013), and between human antimicrobial consumption and AMR specifically in WHO critical priority (1 center dot 06 [1 center dot 00-1 center dot 12]; p=0 center dot 035) and high priority (1 center dot 22 [1 center dot 09-1 center dot 37]; p