Global antibiotic use and resistance

Background: The ability of national and regional policy to respond to the threat of antimicrobial resistance (AMR) is challenged by the lack of adequate data on resistance and antimicrobial consumption. The problem of insufficient data is global in nature, but is particularly acute in South and Southeast Asia and sub-Saharan Africa where resistance may be increasing most rapidly and where the large, unfinished burden of bacterial infections may result in the largest health consequences of resistance.

Methods: Data on antimicrobial resistance was obtained from public and private hospitals, government agencies, and private labs from 1999-2015. Antibiotic use data were obtained from IMSHealth for the period 1999-2014. Resistance rates were calculated as the percentage of isolates tested that were classified as resistant at the time by CLSI criteria, and for antibiotic use the defined daily dose (DDD) per capita was calculated. In addition, analyses of factors that drive antibiotic use were identified using a panel regression method with non-correlated health and economic indicators for each country.

Results: Antibiotic resistance data from 50 countries and use data from 69 countries were obtained. Increasing resistance to Gram-negative pathogens was observed across the globe, with rates of resistance in many developing countries rising higher than in developed countries. On the antibiotic use side, while developed countries generally have the highest rates of antibiotic use per capita, developing countries have seen rapidly rising rates of use, particularly for drugs of last resort such as the carbapenems. Analysis of the factors driving use found stark differences between developed and developing countries, particularly with respect to income, which was a major driver in low-income countries but not in developed countries.

Conclusion: Increased understanding of antimicrobial use and resistance worldwide is necessary for combating antibiotic resistance. Data from this report will assist policy-makers, epidemiologists, and healthcare providers in developing solutions to this significant problem of global health.