title: Antimicrobial resistance: the major contribution of poor governance and corruption to this growing problem.
abstract: OBJECTIVE
  To determine how important governmental, social, and economic factors are in driving antibiotic resistance compared to the factors usually considered the main driving factors-antibiotic usage and levels of economic development.
  
  
  METHODS
  A retrospective multivariate analysis of the variation of antibiotic resistance in Europe in terms of human antibiotic usage, private health care expenditure, tertiary education, the level of economic advancement (per capita GDP), and quality of governance (corruption). The model was estimated using a panel data set involving 7 common human bloodstream isolates and covering 28 European countries for the period 1998-2010.
  
  
  RESULTS
  Only 28% of the total variation in antibiotic resistance among countries is attributable to variation in antibiotic usage. If time effects are included the explanatory power increases to 33%. However when the control of corruption indicator is included as an additional variable, 63% of the total variation in antibiotic resistance is now explained by the regression. The complete multivariate regression only accomplishes an additional 7% in terms of goodness of fit, indicating that corruption is the main socioeconomic factor that explains antibiotic resistance. The income level of a country appeared to have no effect on resistance rates in the multivariate analysis. The estimated impact of corruption was statistically significant (p< 0.01). The coefficient indicates that an improvement of one unit in the corruption indicator is associated with a reduction in antibiotic resistance by approximately 0.7 units. The estimated coefficient of private health expenditure showed that one unit reduction is associated with a 0.2 unit decrease in antibiotic resistance.
  
  
  CONCLUSIONS
  These findings support the hypothesis that poor governance and corruption contributes to levels of antibiotic resistance and correlate better than antibiotic usage volumes with resistance rates. We conclude that addressing corruption and improving governance will lead to a reduction in antibiotic resistance.
authors.affiliation: ACT Pathology, Canberra Hospital, Australian National University, Garran, Australia; Canberra Clinical School, Australian National University, Garran, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Collignon
authors.affiliation: Arndt-Corden Department of Economics, Australian National University, Acton, Australia; School of Environment and Development, University of Manchester, Manchester, England.
authors.forename: Prema-Chandra
authors.initials: PC
authors.lastname: Athukorala
authors.affiliation: Australian National University, Garran, Australia; Canberra Hospital, Garran, Australia.
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Senanayake
authors.affiliation: Arndt-Corden Department of Economics, Australian National University, Acton, Australia.
authors.forename: Fahad
authors.initials: F
authors.lastname: Khan
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D005060:Europe; D006801:Humans; D008954:Models, Biological; D012959:Socioeconomic Factors
chemical_list: D000900:Anti-Bacterial Agents