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A multivariable analysis of the contribution of socioeconomic and environmental factors to blood culture Escherichia coli resistant to fluoroquinolones in high- and middle-income countries

Abstract:
Background:
Antimicrobial resistance (AMR) is a public health concern. We wanted to determine if various environmental and socioeconomic variables as well as markers of antimicrobial use impacted on the level of AMR in countries of different income levels.
Methods:
We performed cross-national univariate and multivariable analyses using the national proportion of quinolone-resistant Escherichia coli (QREC) in blood culture as the dependent variable. Access to safe water and sanitation, other socioeconomic variables, and human and animal antimicrobial consumption were analysed.
Results:
In middle-income countries, unsafely managed sanitation, corruption and healthcare access and quality were significantly associated with the national proportion of blood culture QREC (%) in univariate analyses, whereas no variables remained significant in the multivariable models. For the multivariable high-income country model, corruption and healthcare access and quality were significantly associated with blood culture QREC (%) levels. For the model including all countries, human fluoroquinolone use, corruption level, livestock and crop production index were significantly associated with blood culture QREC (%) levels in the univariate analyses.
Conclusion:
Corruption is a strong predictor of AMR, likely reflecting a multitude of socioeconomic factors. Sanitation quality contributed to increased blood culture QREC (%) levels in middle-income countries, although was not an independent factor, highlighting the need to also focus on infrastructure such as sanitation services in the context of AMR.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1186/s12889-022-12776-y

Authors

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Institution:
University of Oxford
Division:
MSD
Department:
Primary Care Health Sciences
Oxford college:
Green Templeton College
Role:
Author
ORCID:
0000-0003-2319-9246


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Funder identifier:
https://ror.org/01f80g185
More from this funder
Funder identifier:
https://ror.org/04zbn7k04


Publisher:
BioMed Central
Journal:
BMC Public Health More from this journal
Volume:
22
Issue:
1
Article number:
354
Publication date:
2022-02-19
Acceptance date:
2022-02-02
DOI:
EISSN:
1471-2458


Language:
English
Keywords:
Pubs id:
2129197
Local pid:
pubs:2129197
Deposit date:
2025-06-11
ARK identifier:

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