AUTHOR=Zeng Yingchao , Li Weibin , Zhao Manzhi , Li Jia , Liu Xu , Shi Lin , Yang Xinyi , Xia Haohai , Yang Shifang , Yang Lianping 

TITLE=The association between ambient temperature and antimicrobial resistance of Klebsiella pneumoniae in China: a difference-in-differences analysis

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1158762

DOI=10.3389/fpubh.2023.1158762

ISSN=2296-2565

ABSTRACT=<sec><title>Introduction</title><p>Antimicrobial resistance (AMR) of <italic>Klebsiella pneumoniae</italic> (<italic>K. pneumoniae</italic>) poses a significant global public health threat and is responsible for a high prevalence of infections and mortality. However, knowledge about how ambient temperature influences the AMR of <italic>K. pneumoniae</italic> is limited in the context of global warming.</p></sec><sec><title>Methods</title><p>AMR data of 31 Chinese provinces was collected from the China Antimicrobial Resistance Surveillance System (CARSS) between 2014 and 2020. Socioeconomic and meteorological data were collected from the China Statistical Yearbook during the same period. A modified difference-in-differences (DID) approach was applied to estimate the association between ambient temperature and third-generation cephalosporin-resistant <italic>K. pneumoniae</italic> (3GCRKP) and carbapenem-resistant <italic>K. pneumoniae</italic> (CRKP). Furthermore, moderating effects of socioeconomic factors were also evaluated.</p></sec><sec><title>Results</title><p>Every 1°C increase in annual average temperature was associated with a 4.7% (relative risk (RR):1.047, 95% confidence intervals (CI): 1.031–1.082) increase in the detection rate of 3GCRKP, and a 10.7% (RR:1.107, 95% CI: 1.011–1.211) increase in the detection rate of CRKP. The relationships between ambient temperature and 3GCRKP and CRKP were found to be moderated by socioeconomic status (GDP <italic>per capita</italic>, income <italic>per capita</italic>, and consumption <italic>per capita</italic>; the interaction <italic>p</italic>-values &lt;0.05), where higher economic status was found to strengthen the effects of temperature on the detection rate of 3GCRKP and weaken the effects on the detection rate of CRKP.</p></sec><sec><title>Discussion</title><p>Ambient temperature was found to be positively associated with AMR of <italic>K. pneumoniae</italic>, and this association was moderated by socioeconomic status. Policymakers should consider the impact of global warming and high temperatures on the spread of 3GCRKP and CRKP when developing strategies for the containment of AMR.</p></sec>