Global antimicrobial resistance: a system-wide comprehensive investigation using the Global One Health Index

Abstract

Background Antimicrobial resistance (AMR) is one of the top ten global public health challenges. However, given the lack of a comprehensive assessment of worldwide AMR status, our objective is to develop a One Health-based system-wide evaluation tool on global AMR. Methods We have further developed the three-hierarchical Global One Health Index (GOHI)-AMR indicator scheme, which consists of five key indicators, 17 indicators, and 49 sub-indicators, by incorporating 146 countries’ data from diverse authoritative databases, including WHO's Global Antimicrobial Resistance and Use Surveillance System (GLASS) and the European CDC. We investigated the overall- or sub-rankings of GOHI-AMR at the international/regional/national levels for data preprocessing and score calculation utilizing the existing GOHI methodology. Additionally, a correlation analysis was conducted between the GOHI-AMR and other socioeconomic factors. Results The average GOHI-AMR score for 146 countries is 38.45. As expected, high-income countries (HICs) outperform the other three income groups on overall rankings and all five key indicators of GOHI-AMR, whereas low-income countries unexpectedly outperform upper-middle-income countries and lower-middle-income countries on the antibiotics-resistant key indicator (ARR) and ARR-subordinate indicators, including carbapenem-, β-lactam-, and quinolone resistance, and even HICs on aminoglycoside resistance. There were no significant differences among the four groups on the environmental-monitoring indicator (P > 0.05). GOHI-AMR was positively correlated with gross domestic product, life expectancy, and AMR-related publications, but negatively with natural growth rate and chronic respiratory disease. In contrast to Cyprus, the remarkably lower prevalence of "ESKAPE pathogens" in high-scoring Sweden and Denmark highlights Europe's huge gaps. China and Russia outperformed the other three BRICS countries on all key indicators, particularly India's ARR and Brazil's AMR laboratory network and coordination capacity. Furthermore, significant internal disparities in carbapenem-resistant Klebsiella pneumoniae (CRKP) and methicillin-resistant Staphylococcus aureus (MRSA) prevalence were observed between China and the USA, with MRSA prevalence both gradually declining, whereas CRKP prevalence has been declining in the USA but increasing in China, consistent with higher carbapenems-related indicator’ performance in USA. Conclusions GOHI-AMR is the most comprehensive tool currently available for the assessment of AMR status worldwide. We discovered unique features impacting AMR in each country and offered precise recommendations to improve the capacity to tackle AMR in low-ranking countries. Graphical Abstract

Evolution of Antibiotic Resistance in Escherichia coli and Klebsiella pneumoniae Clinical Isolates in a Multi-Profile Hospital over 5 Years (2017–2021)

“…In the case of carbapenem insusceptibility in these bacteria, the Polish average was 8% with a steady increase after 2016, likely due to the spread of clones producing carbapenem-hydrolyzing enzymes [ 46 ]. In Europe, the share of strains resistant to these antibiotics was estimated at 10% in 2020, while in Asian countries, the percentage was even higher, reaching up to 21% [ 48 , 49 ]. In the analyzed hospital, increasing resistance to this group of drugs was observed from 2019, amounting in 2021 to 12% for meropenem, which is above the national average.…”

“…The decline in susceptibility to these antibiotics can largely be attributed to their overuse. Additionally, the increase in carbapenem use in recent years is contributing to the selection of carbapenemase-producing strains, although this is undoubtedly a trend across Europe [ 48 , 49 ]. It is hoped that these analyses will increase the effectiveness of empirical therapy for suspected Gram-negative bacilli infections, based on the use of antibiotics for which the percentage of susceptible strains is the highest.…”

Socioeconomic and Governance Factors Disentangle the Relationship between Temperature and Antimicrobial Resistance: A 10-Year Ecological Analysis of European Countries

“…To gain a clearer understanding of whether the rise in AMR rates is a result of temperature change or just the convergence of different geographical gradients due to other factors, we further refined our analysis by considering GDP per capita and the governance index. The first is a summary measure of the country’s economic output per person, which was previously associated with climate change and AMR [ 17 , 43 , 44 , 45 ]. As a general trend, there is a correlation between GDP per capita and carbon dioxide (CO 2 ) emissions, where an increase in GDP per capita results in a corresponding rise in CO 2 emissions [ 46 ].…”

“…Moreover, the relationship between GDP per capita and AMR is complex and not well understood. However, some studies suggested that there was a correlation between a country’s wealth and the prevalence of AMR: higher GDP per capita tended to be associated with greater use of antibiotics, higher levels of industrialization and urbanization, and greater exposure to antimicrobial agents, all of which can contribute to the development and spread of AMR [ 17 , 45 ]. On the other hand, higher income can also increase access to better healthcare and improved sanitation, which can reduce the spread of AMR [ 17 , 45 ].…”

Correction: Global antimicrobial resistance: a system-wide comprehensive investigation using the Global One Health Index

“…After publication of this article [ 1 ], it was brought to our attention that one of the authors’ name was incorrectly spelt. The correct name of the author should be Yung-Fu Chang, rather than YunFu Chang.…”