Analysis of European Surveillance of Antimicrobial Consumption/European Antimicrobial Resistance Surveillance Network Data from 29 EEA Countries for Spatiotemporal Associations Between Antimicrobial Consumption and Resistance—Implications for Antimicrobial Stewardship?

Background: Antimicrobial resistance is one of the foremost global health concerns of today and could offset much of the progress accrued in healthcare over the last century. Excessive antibiotic use accelerates this problem but it is recognised that specific agents differ in their capacity to promote resistance, a concept recently promoted by the World Health Organisation in the form of its Access, Watch, Reserve (AWaRe) schema. Which, if any, agents should be construed as having a high proclivity for selection of resistance, has been contested. The European Antimicrobial Resistance Surveillance Network (EARS-NET) and European Surveillance of Antimicrobial Consumption Network (ESAC-NET) curate population level data over time and throughout the European Economic Area (EEA). EARS-NET monitors resistance to antimicrobials amongst invasive isolates of sentinel pathogens whereas ESAC-NET tracks usage of systemic antimicrobials. Methods Using univariate and multivariate regression analyses, spatiotemporal associations between the use of specific antimicrobial classes and 14 key resistance phenotypes in 5 sentinel pathogens were assessed methodically for 29 EEA countries. Results Use of 2ndand 3rd generation cephalosporins, extended spectrum penicillin/β-lactamase inhibitor combinations, carbapenems, fluoroquinolones, nitroimidazoles and macrolides strongly correlated with key resistance phenotypes. Conclusions The data obtained mostly support the WHO AWaRe schema with critical caveats. They have the potential to inform antimicrobial stewardship initiatives in the EEA, highlighting obstacles and shortcomings which may be modified in future to minimise positive selection for problematic resistance.