Association between antibiotic resistance and increasing ambient temperature in China: an ecological study with nationwide panel data

Publication summary

A growing body of research highlights the association between climate-change–related increases in average temperatures and the development of antibiotic resistance in bacterial species that may be particularly susceptible to heat stress. In this study, researchers documented increases in ambient temperatures across China, along with trends in the prevalence of carbapenem resistance  in Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa as obtained from the China Antimicrobial Surveillance Network from 2005 to 2019. Data were adjusted for other factors—gross domestic production per capita, number of health facilities, density of physicians and hospital beds, annual average rainfall and humidity, annual antibiotic use, and perceptions of corruption—that may influence the relationship between temperature rises and antibiotic resistance, with particular attention to the fact that rapid socioeconomic changes in China have previously been associated with a higher prevalence of drug-resistant bacteria.

Who this is for

• Environmental and public health policymakers

Key findings

• Over the 15-year monitoring period, the researchers observed overall trends toward an increasing prevalence of carbapenem-resistant A baumannii and K pneumoniae and a decreasing prevalence of carbapenem-resistant P aeruginosa.
• A increase in ambient temperature of 1° Celsius was associated with a 1.14-fold increase in carbapenem-resistant K pneumoniae and a 1.06-fold increase in carbapenem-resistant P aeruginosa prevalence across China, with no association observed between temperature increases and carbapenem-resistant A baumannii rates.
• A higher prevalence of carbapenem-resistant K pneumoniae and P aeruginosa occurred in Chinese provinces, as opposed to autonomous regions or municipalities directly under the central government, and prevalence of carbapenem resistance was also associated with provinces that had higher average ambient temperatures.
• The authors observed an association between temperature increases and antibiotic resistance across northern China for all three bacteria, during winter for K pneumoniae and P aeruginosa, and during summer for K pneumoniae. Increasing temperatures were less likely to be associated with the development of carbapenem resistance in A baumannii and K pneumoniae across southern China.
• Tibet, Guangxi, Hainan, and Chongqing had a high prevalence of carbapenem-resistant A baumannii and a low prevalence of carbapenem-resistant K pneumoniae and P aeruginosa.
• Factors other than temperature that were associated with a high prevalence of carbapenem resistance included high antibiotic consumption and a high amount of perceived corruption for P aeruginosa, and a lower density of health facilities and a higher density of hospital beds for all three species.
• The authors caution that, due to the effects of temperature increases on the development of drug-resistant bacteria, interventions that attempt to address resistance via reductions in antibiotic use may be slowed or rendered less effective because of climate change.