Global patterns and correlates in the emergence of antimicrobial resistance in humans

Antimicrobial resistance (AMR) is a critical global health threat, and drivers of the emergence of novel strains of antibiotic-resistant bacteria in humans are poorly understood at the global scale. We examined correlates of AMR emergence in humans using global data on the origins of novel strains of AMR bacteria from 2006 to 2017, human and livestock antibiotic use, country economic activity, and reporting bias indicators. We found that AMR emergence is positively correlated with antibiotic consumption in humans, whereas the relationship with antibiotic consumption in livestock is modified by gross domestic product (GDP), with only higher GDP countries showing a slight positive association. We also found that human travel may play a role in AMR emergence, likely driving the spread of novel AMR strains into countries where they are subsequently detected for the first time. Finally, we produced predictive models and country-level maps of the global distribution of AMR risk. We assessed these against spatial patterns of reported AMR emergence, to identify gaps in surveillance that can be used to direct prevention and intervention policies.