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 in China, encompassing 20,762,383 bacterial isolates from the China Antimicrobial Resistance Surveillance System dataset between 2014 and 2022. A regression model was used to explore the relationship of AMR with multiple variables and the avoidable risk of AMR under six different measures during 2019. Results showed positive associations with human and veterinary antibiotic usage, particulate matter smaller than 2.5 µm (PM2.5) level, population density, gross domestic product per capita, and length of hospital stay. PM2.5 might be a major influencing factor of AMR, accounting for 13.7% of variation in aggregate AMR. Despite improvements in decreasing AMR, future initiatives should consider integrated strategies to control PM2.5 and other factors simultaneously to decrease AMR.