National disparities in the relationship between antimicrobial resistance and antimicrobial consumption in Europe: An observational study in 29 Countries

TY - JOUR

T1 - National disparities in the relationship between antimicrobial resistance and antimicrobial consumption in Europe

T2 - An observational study in 29 Countries

AU - McDonnell, Lucy

AU - Armstrong, David

AU - Ashworth, Mark

AU - Dregan, Alexandru

AU - Malik, Umer

AU - White, Patrick

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background: Antimicrobial resistance in invasive infections is driven mainly by human antimicrobial consumption. Limited cross-national comparative evidence exists about variation in antimicrobial consumption and effect on resistance. Methods: We examined the relationship between national community antimicrobial consumption rates (2013) and national hospital antimicrobial resistance rates (2014) across 29 countries in the European Economic Area (EEA). Consumption rates were obtained from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). Resistance data were obtained from the European Antimicrobial Resistance Surveillance Network (EARS-Net), based on 196480 invasive isolates in 2014. Results: Data availability and consistency were good. Some countries did not report figures for each strain of resistant bacteria. National antimicrobial consumption rates (2013) varied from ≥13 DDD (Estonia, the Netherlands and Sweden) to ≥30 DDD (France, Greece and Romania) per 1000 inhabitants per day. National antimicrobial resistance rates (hospital isolates, 15 species) also varied from >6.1% (Finland, Iceland and Sweden) to >37.2% (Bulgaria, Greece, Romania and Slovakia). National antimicrobial consumption rates (2013)showed strong to moderate correlation with national hospital antimicrobial resistance rates (2014) in 19 strains of bacteria (r"0.84 to r"0.39). Some countries defied the trend with high consumption and low resistance (France, Belgium and Luxembourg) or low consumption and high resistance (Bulgaria, Hungary and Latvia). Conclusions: We found associations between national community antimicrobial consumption and national hospital antimicrobial resistance across a wide range of bacteria. These associations were not uniform. Different mechanisms may drive resistance in hospital-based invasive infections. Future research on international variations in antimicrobial resistance should consider environmental factors, agricultural use, vaccination policies and prescribing quality.

AB - Background: Antimicrobial resistance in invasive infections is driven mainly by human antimicrobial consumption. Limited cross-national comparative evidence exists about variation in antimicrobial consumption and effect on resistance. Methods: We examined the relationship between national community antimicrobial consumption rates (2013) and national hospital antimicrobial resistance rates (2014) across 29 countries in the European Economic Area (EEA). Consumption rates were obtained from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). Resistance data were obtained from the European Antimicrobial Resistance Surveillance Network (EARS-Net), based on 196480 invasive isolates in 2014. Results: Data availability and consistency were good. Some countries did not report figures for each strain of resistant bacteria. National antimicrobial consumption rates (2013) varied from ≥13 DDD (Estonia, the Netherlands and Sweden) to ≥30 DDD (France, Greece and Romania) per 1000 inhabitants per day. National antimicrobial resistance rates (hospital isolates, 15 species) also varied from >6.1% (Finland, Iceland and Sweden) to >37.2% (Bulgaria, Greece, Romania and Slovakia). National antimicrobial consumption rates (2013)showed strong to moderate correlation with national hospital antimicrobial resistance rates (2014) in 19 strains of bacteria (r"0.84 to r"0.39). Some countries defied the trend with high consumption and low resistance (France, Belgium and Luxembourg) or low consumption and high resistance (Bulgaria, Hungary and Latvia). Conclusions: We found associations between national community antimicrobial consumption and national hospital antimicrobial resistance across a wide range of bacteria. These associations were not uniform. Different mechanisms may drive resistance in hospital-based invasive infections. Future research on international variations in antimicrobial resistance should consider environmental factors, agricultural use, vaccination policies and prescribing quality.

UR - http://www.scopus.com/inward/record.url?scp=85040165620&partnerID=8YFLogxK

U2 - 10.1093/jac/dkx248

DO - 10.1093/jac/dkx248

M3 - Article

AN - SCOPUS:85040165620

SN - 0305-7453

VL - 72

SP - 3199

EP - 3204

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

IS - 11

ER -