ArticleNature microbiology2019
A nonlinear time-series analysis approach to identify thresholds in associations between population antibiotic use and rates of resistance.
Article in Nature microbiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 42 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
42 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Linking antimicrobial resistance surveillance to antibiotic policy in healthcare settings: the COMBACTE-Magnet EPI-Net COACH project.The Journal of antimicrobial chemotherapy · 2020Pooled it
- Global Trends in Antimicrobial Resistance-Related Mortality fromTropical medicine and infectious disease · 2026Article
- Exploring the association of antibiotic consumption on resistance: evidence from Catalonia (Spain) using a threshold regression approach.BMJ public health · 2026Article
- Spectrum, dose, and duration of antibiotic exposure and risk of intensive care unit-acquired carbapenem-resistant gram-negative bacteria: a prospective cohort study.Annals of intensive care · 2025Article
- A One Health Comparative Study of MDRAntibiotics (Basel, Switzerland) · 2025Article
- Correlation Between Antimicrobial Consumption and Resistance inAntibiotics (Basel, Switzerland) · 2025Article
- Dynamic association of antimicrobial resistance in urinary isolates ofThe Lancet regional health. Europe · 2025Article
- Pharmaco-Epidemiological Study and Correlation Between Antibiotic Resistance and Antibiotic Consumption in a Tunisian Teaching Hospital from 2010 to 2022.Antibiotics (Basel, Switzerland) · 2025Article
- Antibiotic Use Thresholds for Carbapenem-Resistant Gram-Negative Bacteria: A Nonlinear Time-Series Study.Infection and drug resistance · 2025Article
- Overprescription of antibiotics in Brazilian dental clinics: an evaluation of current practices.Scientific reports · 2024Article
- Predicting future hospital antimicrobial resistance prevalence using machine learning.Communications medicine · 2024Article
- The Medicines Optimisation Innovation Centre: a dedicated centre driving innovation in medicines optimisation-impact and sustainability.International journal of clinical pharmacy · 2024Article
- Long-Term Clinical and Ecological Impact of an Antimicrobial Stewardship Program on the Incidence of Carbapenem-ResistantAntibiotics (Basel, Switzerland) · 2024Article
- [Antibiotic stewardship programs in the Spanish emergency services: PROA-URG Study].Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2024Article
- Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-ResistantAntibiotics (Basel, Switzerland) · 2024Article
- The effect of the antibiotic stewardship program (ASP) on community-acquired pneumonia (CAP): a before-after study.Frontiers in pharmacology · 2024Article
- Acinetobacter baumannii: assessing susceptibility patterns, management practices, and mortality predictors in a tertiary teaching hospital in Lebanon.Antimicrobial resistance and infection control · 2023Observational
- Challenges in Forecasting Antimicrobial Resistance.Emerging infectious diseases · 2023Review
- Systematic review of time lag between antibiotic use and rise of resistant pathogens among hospitalized adults in Europe.JAC-antimicrobial resistance · 2023Review
- Routine Antiretroviral Pharmacy Refill Information Can Predict Failure Postpartum in Previously Suppressed South African Women With HIV.Open forum infectious diseases · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
17 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Balancing access to antibiotics with the control of antibiotic resistance is a global public health priority. At present, antibiotic stewardship is informed by a 'use it and lose it' principle, in which antibiotic use by the population is linearly related to resistance rates. However, theoretical and mathematical models suggest that use-resistance relationships are nonlinear. One explanation for this is that resistance genes are commonly associated with 'fitness costs' that impair the replication or transmissibility of the pathogen. Therefore, resistant genes and pathogens may only gain a survival advantage where antibiotic selection pressures exceed critical thresholds. These thresholds may provide quantitative targets for stewardship-optimizing the control of resistance while avoiding over-restriction of antibiotics. Here, we evaluated the generalizability of a nonlinear time-series analysis approach for identifying thresholds using historical prescribing and microbiological data from five populations in Europe. We identified minimum thresholds in temporal relationships between the use of selected antibiotics and incidence rates of carbapenem-resistant Acinetobacter baumannii (Hungary), extended-spectrum β-lactamase-producing Escherichia coli (Spain), cefepime-resistant E. coli (Spain), gentamicin-resistant Pseudomonas aeruginosa (France) and methicillin-resistant Staphylococcus aureus (Northern Ireland) in different epidemiological phases. Using routinely generated data, our approach can identify context-specific quantitative targets for rationalizing population antibiotic use and controlling resistance. Prospective intervention studies that restrict antibiotic consumption are needed to validate these thresholds.
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