Global AMR emergence rates are linked to human antibiotic consumption and mobility.

One Health Trust’s Ramanan Laxminarayan and Thomas Van Boeckel collaborated with the EcoHealth Alliance to author a study that investigated the correlation between the emergence of novel antimicrobial-resistant (AMR) pathogens and human and livestock antimicrobial use, country economic activity, inbound human travel, antibiotic production, and biomedical surveillance efforts.

Using country-specific AMR emergence event counts, which were adjusted for reporting bias, from 60 countries between 2006 and 2017, the researchers’ model revealed that human per capita antibiotic consumption was positively correlated with AMR emergence rates (incidence rate ratio = 1.04 per defined daily dose per capita; 95% CI: 1.00-1.08). In countries expected to have AMR emergence events, the AMR emergence rate was 36 percent more than the average rate when human antibiotic consumption was twice the average. Gross domestic product (GDP) per capita was also positively associated with AMR emergence rates (IRR = 7.1 per log-dollars per capita; 1.8-22). Countries with lower per capita GDP were also less likely to report any emergence events (odds ratio = 0.18 per log-dollars per capita; 0.051-0.51). Furthermore, livestock antibiotic use and AMR emergence rates were positively associated in higher GDP countries, and this effect strengthened as national GDP increased (IRR = 0.019 per log of kg antibiotics consumed by livestock per human capita; 0.0017-0.51). Meanwhile, as livestock antibiotic consumption increased in lower GDP countries, AMR emergence rates decreased. Inbound tourism volume per country, representing human mobility, was positively correlated with AMR emergence rates (IRR = 1.3 per log of inbound tourists per capita; 1.2-1.5). Conversely, antibiotic exports in dollars was negatively associated with AMR emergence rates (IRR = 0.90 per log of antibiotic exports per capita; 0.84-0.95).

The researchers then used their model to estimate reporting-corrected AMR emergence rates for each country. The results showed higher predicted rates for nearly three-fourths of countries, including those with the highest and lowest reported counts of AMR emergence events. The greatest increases were predicted in Russia, Saudi Arabia, and Azerbaijan, which all reported zero emergence events. These findings highlight the need for robust AMR surveillance and reporting in countries currently lacking these systems.

Read the full article, published in Proceedings of the Royal Society B, here.