Influence of population density on antibiotic resistance

Abstract

Antibiotic consumption and population density as a measure of crowding in the community were related to the prevalence of antibiotic resistance of three cities in three different countries: St Johns in Newfoundland (Canada), Athens in Greece and Groningen in The Netherlands. Antibiotic consumption was expressed in DDD (defined daily dose), as DID (DDD/1000 inhabitants/day) and as DSD (DDD/km(2)). The prevalence of antibiotic-resistant Escherichia coli and enterococci was determined in faecal samples of healthy volunteers. In both Newfoundland (28 DID) and Greece (29 DID) the overall consumption of antibiotics was more than three times higher compared with that of The Netherlands (9 DID). The lowest prevalence of resistant E. coli against the majority of antibiotics tested was found for the samples from Newfoundland and was significant (P < 0.05) for cefazolin, oxytetracycline and trimethoprim. A poor correlation between the number of DID and the prevalence of resistance was observed [the Pearson correlation coefficient (Pcc) ranged between -0.93 and 0.87]. However, when population density was taken into consideration and antibiotic consumption was expressed in DSD, a strong correlation was observed (and Pcc ranged between 0.86 and 1.00). This study suggests that population density is an important factor in the development of antibiotic resistance and warrants special attention as a factor in resistance epidemiology.

Evolution of resistance patterns and identification of risk factors for Streptococcus pneumoniae colonisation in daycare centre attendees in Athens, Greece

“…Surveys have produced contradictory results, as different antibiotics appear to exhibit different selection powers [5,15]. Apart from antibiotic consumption, other factors such as the high turnover of respiratory pathogens in daycare centres, clonal spread of resistant strains, natural fluctuations and the high population density have all been held responsible for resistance [16].…”

Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries

“…Studies of the Tama River in Tokyo and the Cumberland River in Nashville, Tennessee (United States) showed that fecal bacteria concentrations, possibly originating from sewer overflows, were significantly affected by population density (Ham et al 2009;Young and Thackston 1999). An aggregated (or "ecological") study across three developed countries also found suggestive evidence that higher population density may be related to increased antibiotic resistance because higher interpersonal contact can lead to the spread of resistant bacteria (Bruinsma et al 2003).…”

Infection due to travel-related carbapenemase-producingEnterobacteriaceae, a largely underestimated phenomenon in Belgium

“…Several publications suggest a link between population density (and overcrowding) and the prevalence of antimicrobial resistance, 21,22 increasing the number of resistant bacteria circulating in the community and increasing the risk for cross-transmission between humans living in proximity. Urban areas, especially from the largest towns in Belgium, may cumulate several potential risk factors for import and dissemination of CPE: a high population density coupled with a dense healthcare network, concentration of university hospitals, larger proportion of immigrants, asylum seekers and refugees, and higher number of tourist travellers.…”