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

Although previous studies showed that warmer temperatures may be associated with increased antimicrobial resistance (AMR) rates, unmeasured factors may explain the observed relationship. We conducted a ten-year ecological analysis to evaluate whether temperature change was associated with AMR across 30 European countries, considering predictors that can determine a geographical gradient. Using four data sources, we created a dataset of: annual temperature change (FAOSTAT database); AMR proportions for ten pathogen-antibiotic combinations (ECDC atlas); consumption of antibiotics for systemic use in the community (ESAC-Net database); population density, gross domestic product (GDP) per capita, and governance indicators (World Bank DataBank). Data were obtained for each country and year (2010-2019) and analyzed through multivariable models. We found evidence of a positive linear association between temperature change and AMR proportion across all countries, years, pathogens, and antibiotics (beta = 0.140; 95%CI = 0.039; 0.241; p = 0.007), adjusting for the effect of covariates. However, when GDP per capita and the governance index were included in the multivariable model, temperature change was no longer associated with AMR. Instead, the main predictors were antibiotic consumption (beta = 0.506; 95%CI = 0.366; 0.646; p < 0.001), population density (beta = 0.143; 95%CI = 0.116; 0.170; p < 0.001), and the governance index (beta = -1.043; 95%CI = -1.207; -0.879; p < 0.001). Ensuring the appropriate use of antibiotics and improving governance efficiency are the most effective ways of counteracting AMR. It is necessary to conduct further experimental studies and obtain more detailed data to investigate whether climate change affects AMR.