Effect of social and climatological factors on antimicrobial use and Streptococcus pneumoniae resistance in different provinces in Spain.
OBJECTIVE
To investigate the association between geographical differences in antibiotic consumption and resistance of Streptococcus pneumoniae to penicillin and erythromycin in 15 provinces of Spain, taking into account the potential influence of a series of social and climatological factors.


METHODS
Possible correlations between prevalence of resistance to penicillin and erythromycin of S. pneumoniae, as determined in the national reference laboratory, and antibiotic consumption, and socio-economic and climatological variables were investigated. Partial correlations and multivariate linear regression were performed to assess the relative importance of variables predicting resistance and to investigate explicative factors for antibiotic consumption, respectively.


RESULTS
A correlation was found between resistance and educational level, the proportion of young people in the population and climate, but was explained by their effects on differences in antibiotic use, which appeared to be the basic and only force behind resistance patterns in different geographical areas. Antibiotic use was found to be determined by the interplay of adult illiteracy, rainfall and GDP per capita.


CONCLUSIONS
Interventions aimed at improving educational level and economic growth might therefore be followed by a noticeable reduction in overall antibiotic consumption, which might in turn be followed by a reduction in penicillin and erythromycin resistance in clinical isolates of S. pneumoniae.
García-Rey
César
C
Medical Department, GlaxoSmithKline, Parque Tecnológico de Madrid, C/Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain. cesar.garcia-rey@gsk.com
Fenoll
Asunción
A
Aguilar
Lorenzo
L
Casal
Julio
J
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002980:Climate; D003469:Culture; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D005260:Female; D006295:Health Resources; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D013030:Spain; D013296:Streptococcus pneumoniae / Q000187:drug effects*
D000900:Anti-Bacterial Agents