McGough Sarah F, MacFadden Derek R, Hattab Mohammad W, Mølbak Kåre, Santillana Mauricio
Harvard T.H. Chan School of Public Health, Harvard University, Boston, United States.
Computational Health Informatics Program, Boston Children's Hospital, Boston, United States.
Euro Surveill. 2020 Nov;25(45). doi: 10.2807/1560-7917.ES.2020.25.45.1900414.
BackgroundThe rapid increase of bacterial antibiotic resistance could soon render our most effective method to address infections obsolete. Factors influencing pathogen resistance prevalence in human populations remain poorly described, though temperature is known to contribute to mechanisms of spread.AimTo quantify the role of temperature, spatially and temporally, as a mechanistic modulator of transmission of antibiotic resistant microbes.MethodsAn ecologic analysis was performed on country-level antibiotic resistance prevalence in three common bacterial pathogens across 28 European countries, collectively representing over 4 million tested isolates. Associations of minimum temperature and other predictors with change in antibiotic resistance rates over 17 years (2000-2016) were evaluated with multivariable models. The effects of predictors on the antibiotic resistance rate change across geographies were quantified.ResultsDuring 2000-2016, for and , European countries with 10°C warmer ambient minimum temperatures compared to others, experienced more rapid resistance increases across all antibiotic classes. Increases ranged between 0.33%/year (95% CI: 0.2 to 0.5) and 1.2%/year (95% CI: 0.4 to 1.9), even after accounting for recognised resistance drivers including antibiotic consumption and population density. For a decreasing relationship of -0.4%/year (95% CI: -0.7 to 0.0) was found for meticillin resistance, reflecting widespread declines in meticillin-resistant across Europe over the study period.ConclusionWe found evidence of a long-term effect of ambient minimum temperature on antibiotic resistance rate increases in Europe. Ambient temperature might considerably influence antibiotic resistance growth rates, and explain geographic differences observed in cross-sectional studies. Rising temperatures globally may hasten resistance spread, complicating mitigation efforts.
背景
细菌对抗生素耐药性的迅速增加可能很快使我们应对感染的最有效方法过时。尽管已知温度有助于传播机制，但影响人群中病原体耐药性流行的因素仍描述甚少。
目的
在空间和时间上量化温度作为抗生素耐药微生物传播的机制调节因子的作用。
方法
对28个欧洲国家三种常见细菌病原体的国家层面抗生素耐药性流行情况进行了生态分析，总共代表了超过400万个检测分离株。使用多变量模型评估最低温度和其他预测因子与17年（2000 - 2016年）抗生素耐药率变化的关联。量化了预测因子对不同地区抗生素耐药率变化的影响。
结果
在2000 - 2016年期间，对于[具体细菌1]和[具体细菌2]，与其他国家相比，环境最低温度高10°C的欧洲国家在所有抗生素类别中耐药性增加更快。增加幅度在每年0.33%（95%可信区间：0.2至0.5）至每年1.2%（95%可信区间：0.4至1.9）之间，即使在考虑了包括抗生素消费和人口密度等公认的耐药驱动因素之后。对于[具体细菌3]，发现甲氧西林耐药性呈每年 -0.4%（95%可信区间： -0.7至0.0）的下降关系，反映了在研究期间欧洲耐甲氧西林[具体细菌3]的普遍下降。
结论
我们发现环境最低温度对欧洲抗生素耐药率增加有长期影响的证据。环境温度可能会极大地影响抗生素耐药性增长率，并解释横断面研究中观察到的地理差异。全球气温上升可能会加速耐药性传播，使缓解努力复杂化。
