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Determinants of Antimicrobial Resistance among the Different European Countries: More than Human and Animal Antimicrobial Consumption.

ABSTRACT: Although antimicrobial consumption is considered the main driver of antimicrobial resistance (AMR), other factors probably have a significant but less studied impact. The study's goal was to assess AMR drivers across different European countries and quantify their possible contributions using the latest data available. Using the ESAC-Net (European Surveillance of Antimicrobial Consumption Network) database, the ESVAC (European Surveillance of Veterinary Antimicrobial Consumption) database and the OECD (Organisation for Economic Cooperation and Development) information, a dataset including 23 European countries was created. Associations between AMR and potential contributing factors were assessed using bivariate correlation and multiple linear regression models for multivariable analyses. Factors associated with the AMR rate among European countries were human ambulatory consumption of antibiotics and per capita expenditure on health, meaning that the higher human ambulatory consumption of antibiotics and the lower the per capita expenditure on health, the higher the AMR. Both variables together explain 74% of AMR variation. Private expenditure on health in terms of % GDP (Gross Domestic Profit) was positively related to a higher AMR rate. In conclusion, considering antibiotic consumption as the most important factor contributing to AMR may be a deviant focus, as resistance transmission may be paramount for AMR levels. Low per capita expenditure on health, probably a surrogate of worse healthcare conditions and a high level of resistance transmission, has a strong correlation with the AMR rate. Increasing public expenditure on healthcare, to strengthen infection control structures and processes interventions, seems relevant to tackle antimicrobial resistance at the European scale.

SUBMITTER: Silva AC

PROVIDER: S-EPMC8300618 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Salmonella genomic island 1 (SGI1) contains a multidrug resistance region conferring the ampicillin-chloramphenicol-streptomycin-sulfamethoxazole-tetracycline resistance phenotype encoded by bla(PSE-1), floR, aadA2, sul1, and tet(G). Its increasing spread via interbacterial transfer and the emergence of new variants are important public health concerns. We investigated the molecular properties of SGI1-carrying Salmonella enterica serovars selected from a European strain collection. A total of 38 strains belonging to S. enterica serovar Agona, S. enterica serovar Albany, S. enterica serovar Derby, S. enterica serovar Kentucky, S. enterica serovar Newport, S. enterica serovar Paratyphi B dT+, and S. enterica serovar Typhimurium, isolated between 2002 and 2006 in eight European countries from humans, animals, and food, were subjected to antimicrobial susceptibility testing, molecular typing methods (XbaI pulsed-field gel electrophoresis [PFGE], plasmid analysis, and multilocus variable-number tandem-repeat analysis [MLVA]), as well as detection of resistance and virulence determinants (PCR/sequencing and DNA microarray analysis). Typing experiments revealed wide heterogeneity inside the strain collection and even within serovars. PFGE analysis distinguished a total of 26 different patterns. In contrast, the characterization of the phenotypic and genotypic antimicrobial resistance revealed serovar-specific features. Apart from the classical SGI1 organization found in 61% of the strains, seven different variants were identified with antimicrobial resistance properties associated with SGI1-A (S. Derby), SGI1-C (S. Derby), SGI1-F (S. Albany), SGI1-L (S. Newport), SGI1-K (S. Kentucky), SGI1-M (S. Typhimurium), and, eventually, a novel variant similar to SGI1-C with additional gentamicin resistance encoded by aadB. Only minor serovar-specific differences among virulence patterns were detected. In conclusion, the SGI1 carriers exhibited pathogenetic backgrounds comparable to the ones published for susceptible isolates. However, because of their multidrug resistance, they may be more relevant in clinical settings.

Project description:ImportanceSoft drinks are frequently consumed, but whether this consumption is associated with mortality risk is unknown and has been understudied in European populations to date.ObjectiveTo examine the association between total, sugar-sweetened, and artificially sweetened soft drink consumption and subsequent total and cause-specific mortality.Design, setting, and participantsThis population-based cohort study involved participants (n = 451 743 of the full cohort) in the European Prospective Investigation into Cancer and Nutrition (EPIC), an ongoing, large multinational cohort of people from 10 European countries (Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom), with participants recruited between January 1, 1992, and December 31, 2000. Excluded participants were those who reported cancer, heart disease, stroke, or diabetes at baseline; those with implausible dietary intake data; and those with missing soft drink consumption or follow-up information. Data analyses were performed from February 1, 2018, to October 1, 2018.ExposureConsumption of total, sugar-sweetened, and artificially sweetened soft drinks.Main outcomes and measuresTotal mortality and cause-specific mortality. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models adjusted for other mortality risk factors.ResultsIn total, 521 330 individuals were enrolled. Of this total, 451 743 (86.7%) were included in the study, with a mean (SD) age of 50.8 (9.8) years and with 321 081 women (71.1%). During a mean (range) follow-up of 16.4 (11.1 in Greece to 19.2 in France) years, 41 693 deaths occurred. Higher all-cause mortality was found among participants who consumed 2 or more glasses per day (vs consumers of <1 glass per month) of total soft drinks (hazard ratio [HR], 1.17; 95% CI, 1.11-1.22; P < .001), sugar-sweetened soft drinks (HR, 1.08; 95% CI, 1.01-1.16; P = .004), and artificially sweetened soft drinks (HR, 1.26; 95% CI, 1.16-1.35; P < .001). Positive associations were also observed between artificially sweetened soft drinks and deaths from circulatory diseases (≥2 glasses per day vs <1 glass per month; HR, 1.52; 95% CI, 1.30-1.78; P < .001) and between sugar-sweetened soft drinks and deaths from digestive diseases (≥1 glass per day vs <1 glass per month; HR, 1.59; 95% CI, 1.24-2.05; P < .001).Conclusions and relevanceThis study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.

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Determinants of Antimicrobial Resistance among the Different European Countries: More than Human and Animal Antimicrobial Consumption.

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