Factors associated with clinical antimicrobial resistance in China: a nationwide analysis

Antimicrobial resistance (AMR) is a global health threat, and a “One Health” perspective was used to evaluate the association of human and veterinary antibiotic usage, environmental factors, socio-economic factors, and healthcare factors with clinical AMR in China. The study analyzed data from 31 provincial-level administrative divisions, revealing positive associations with human and veterinary antibiotic usage, particulate matter, population density, GDP per capita, and hospital stay length. Negative associations were found with city water popularity, greenery area, and health expenditure per capita. PM2.5 was found to be a major infuencer of AMR, accounting for 13.7% of variation in aggregate AMR. Comprehensive measures could decrease nationalwide aggregate AMR by 8.5, 0.5, 1.3, 4.4, and 17.2%, respectively.