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Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions
BACKGROUND: Emerging research has provided evidence suggesting the potential influence of governance on the development and spread of antimicrobial resistance (AMR), accounting for significant disparities observed both between and within countries. In our study, we conducted an ecological analysis t...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10662482/ https://www.ncbi.nlm.nih.gov/pubmed/37990283 http://dx.doi.org/10.1186/s13756-023-01337-6 |
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author | Maugeri, Andrea Barchitta, Martina Agodi, Antonella |
author_facet | Maugeri, Andrea Barchitta, Martina Agodi, Antonella |
author_sort | Maugeri, Andrea |
collection | PubMed |
description | BACKGROUND: Emerging research has provided evidence suggesting the potential influence of governance on the development and spread of antimicrobial resistance (AMR), accounting for significant disparities observed both between and within countries. In our study, we conducted an ecological analysis to investigate the relationship between governance quality, antibiotic consumption, and AMR across Italian regions. METHODS: By leveraging data from three distinct sources at the regional level, we compiled a comprehensive dataset comprising: AMR proportions for three specific pathogen-antibiotic combinations in the year 2021, antibiotic consumption data for systemic use in the year 2020, and the 2021 European Quality of Government Index (EQI) and its corresponding pillars. Employing mediation analysis, we investigated the potential mediating role of antibiotic consumption in the association between the EQI and an average measure of AMR. RESULTS: Our analysis revealed substantial variation in the percentages of AMR across different regions in Italy, demonstrating a discernible North-to-South gradient concerning both antibiotic usage and governance quality. The EQI exhibited a statistically significant negative correlation with both antibiotic consumption and AMR percentages, encompassing both specific combinations and their average value. Regions characterized by higher levels of governance quality consistently displayed lower values of antibiotic consumption and AMR, while regions with lower governance quality tended to exhibit higher levels of antibiotic use and AMR. Furthermore, we observed a significant total effect of the EQI on average AMR (β = − 0.97; CI − 1.51; − 0.43). Notably, this effect was found to be mediated by antibiotic consumption, as evidenced by a significant indirect effect (β = − 0.89; CI − 1.45; − 0.32). CONCLUSIONS: These findings draw attention to the regional disparities observed in AMR levels, antibiotic consumption patterns, and governance quality in Italy. Our study also highlights the mediating role of antibiotic consumption in the relationship between governance quality and AMR. This underscores the significance of implementing focused interventions and policies aimed at improving governance quality and promoting responsible antibiotic use. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-023-01337-6. |
format | Online Article Text |
id | pubmed-10662482 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-106624822023-11-21 Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions Maugeri, Andrea Barchitta, Martina Agodi, Antonella Antimicrob Resist Infect Control Research BACKGROUND: Emerging research has provided evidence suggesting the potential influence of governance on the development and spread of antimicrobial resistance (AMR), accounting for significant disparities observed both between and within countries. In our study, we conducted an ecological analysis to investigate the relationship between governance quality, antibiotic consumption, and AMR across Italian regions. METHODS: By leveraging data from three distinct sources at the regional level, we compiled a comprehensive dataset comprising: AMR proportions for three specific pathogen-antibiotic combinations in the year 2021, antibiotic consumption data for systemic use in the year 2020, and the 2021 European Quality of Government Index (EQI) and its corresponding pillars. Employing mediation analysis, we investigated the potential mediating role of antibiotic consumption in the association between the EQI and an average measure of AMR. RESULTS: Our analysis revealed substantial variation in the percentages of AMR across different regions in Italy, demonstrating a discernible North-to-South gradient concerning both antibiotic usage and governance quality. The EQI exhibited a statistically significant negative correlation with both antibiotic consumption and AMR percentages, encompassing both specific combinations and their average value. Regions characterized by higher levels of governance quality consistently displayed lower values of antibiotic consumption and AMR, while regions with lower governance quality tended to exhibit higher levels of antibiotic use and AMR. Furthermore, we observed a significant total effect of the EQI on average AMR (β = − 0.97; CI − 1.51; − 0.43). Notably, this effect was found to be mediated by antibiotic consumption, as evidenced by a significant indirect effect (β = − 0.89; CI − 1.45; − 0.32). CONCLUSIONS: These findings draw attention to the regional disparities observed in AMR levels, antibiotic consumption patterns, and governance quality in Italy. Our study also highlights the mediating role of antibiotic consumption in the relationship between governance quality and AMR. This underscores the significance of implementing focused interventions and policies aimed at improving governance quality and promoting responsible antibiotic use. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-023-01337-6. BioMed Central 2023-11-21 /pmc/articles/PMC10662482/ /pubmed/37990283 http://dx.doi.org/10.1186/s13756-023-01337-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Maugeri, Andrea Barchitta, Martina Agodi, Antonella Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions |
title | Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions |
title_full | Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions |
title_fullStr | Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions |
title_full_unstemmed | Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions |
title_short | Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions |
title_sort | association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of italian regions |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10662482/ https://www.ncbi.nlm.nih.gov/pubmed/37990283 http://dx.doi.org/10.1186/s13756-023-01337-6 |
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