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Antibiotic resistance increases with local temperature

Nature Climate Changevolume 8pages510514 (2018) | Download Citation


Bacteria that cause infections in humans can develop or acquire resistance to antibiotics commonly used against them1,2. Antimicrobial resistance (in bacteria and other microbes) causes significant morbidity worldwide, and some estimates indicate the attributable mortality could reach up to 10 million by 20502,3,4. Antibiotic resistance in bacteria is believed to develop largely under the selective pressure of antibiotic use; however, other factors may contribute to population level increases in antibiotic resistance1,2. We explored the role of climate (temperature) and additional factors on the distribution of antibiotic resistance across the United States, and here we show that increasing local temperature as well as population density are associated with increasing antibiotic resistance (percent resistant) in common pathogens. We found that an increase in temperature of 10 °C across regions was associated with an increases in antibiotic resistance of 4.2%, 2.2%, and 2.7% for the common pathogens Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus. The associations between temperature and antibiotic resistance in this ecological study are consistent across most classes of antibiotics and pathogens and may be strengthening over time. These findings suggest that current forecasts of the burden of antibiotic resistance could be significant underestimates in the face of a growing population and climate change4.

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  1. 1.

    Holmes, A. H. et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 387, 176–187 (2016).

  2. 2.

    Nathan, C. & Cars, O. Antibiotic resistance—problems, progress, and prospects. N. Engl. J. Med. 371, 1761–1763 (2014).

  3. 3.

    Global Action Plan on Antimicrobial Resistance (World Health Organization, 2015).

  4. 4.

    O’Neill, J. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations (HM Government and Wellcome Trust, 2016).

  5. 5.

    Patz, J. A. et al. in Climate Change and Human Health: Risks and Responses (eds McMichael, A. J. et al.) Ch. 6 (World Health Organization, Geneva, 2003); www.who.int/globalchange/environment/en/chapter6.pdf

  6. 6.

    Feero, W. G., Guttmacher, A. E. & Relman, D. A. Microbial genomics and infectious diseases. N. Engl. J. Med 365, 347–357 (2011).

  7. 7.

    Wellington, E. M. H. et al. The role of the natural environment in the emergence of antibiotic resistance in Gram-negative bacteria. Lancet Infect. Dis. 13, 155–165 (2013).

  8. 8.

    Lorenz, M. G. & Wackernagel, W. Bacterial gene transfer by natural genetic transformation in the environment. Microbiol. Rev. 58, 563–602 (1994).

  9. 9.

    Walsh, T. R., Weeks, J., Livermore, D. M. & Toleman, M. A. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study. Lancet Infect. Dis. 11, 355–362 (2011).

  10. 10.

    MacFadden, D. R. et al. A platform for monitoring regional antimicrobial resistance, using online data sources: ResistanceOpen. J. Infect. Dis. 214, S393–S398 (2016).

  11. 11.

    Fridken, S. Antibiotic Resistance Patient Safety Atlas (Centers for Disease Control and Prevention, 2016); https://gis.cdc.gov/grasp/PSA/indexAU.html

  12. 12.

    General Population and Housing Characteristics: 2010 Demographic Profile (US Census Bureau, 2010); https://factfinder.census.gov

  13. 13.

    Peleg, A. Y. & Hooper, D. C. Hospital-acquired infections due to Gram-negative bacteria. N. Engl. J. Med. 362, 1804–1813 (2010).

  14. 14.

    Boucher, H. W. et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin. Infect. Dis. 48, 1–12 (2009).

  15. 15.

    Arguez, A. et al. NOAA’s 1981–2010 US NOAA’s 1981–2010 U.S. climate normals: an overview. Bull. Am. Meteorol. Soc. 93, 1687–1697 (2012).

  16. 16.

    Sutherst, R. W. Global change and human vulnerability to vector-borne diseases. Clin. Microbiol. Rev. 17, 136–173 (2004).

  17. 17.

    Clarke, A. et al. A low temperature limit for life on Earth. PLoS ONE 8, e66207 (2013).

  18. 18.

    Hicks, L. A., Taylor, T. H. Jr & Hunkler, R. J. US outpatient antibiotic prescribing, 2010. N. Engl. J. Med. 368, 1461–1462 (2013).

  19. 19.

    Hicks, L. A. et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin. Infect. Dis. 60, 1308–1316 (2015).

  20. 20.

    Hilty, M. et al. Transmission dynamics of extended-spectrum β-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting. Clin. Infect. Dis. 55, 967–975 (2012).

  21. 21.

    Warnes, S. L., Highmore, C. J. & Keevil, C. W. Horizontal transfer of antibiotic resistance genes on abiotic touch surfaces: implications for public health. mBio 3, e00489 (2012).

  22. 22.

    Goossens, H., Ferech, M., van der Stichele, R., Elseviers, M. & ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 365, 579–587 (2005).

  23. 23.

    Poirel, L., Potron, A. & Nordmann, P. OXA-48-like carbapenemases: the phantom menace. J. Antimicrob. Chemother. 67, 1597–1606 (2012).

  24. 24.

    Liu, Y.-Y. et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect. Dis. 16, 161–168 (2016).

  25. 25.

    Shah, H. N. & Gharbia, S. E. The impact of the environment on human infections. Microb. Ecol. Health Dis. 11, 248–254 (1999).

  26. 26.

    Ratkowsky, D. A., Olley, J., Mcmeekin, T. A. & Ball, A. A. Relationship between temperature and growth rate of bacterial cultures. J. Bacteriol. 149, 1–5 (1982).

  27. 27.

    Dipl-Vw, K. K., Frank, U., Conrad, A. & Meyer, E. Seasonal and ascending trends in the incidence of carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species in 2 German hospitals. Infect. Control Hosp. Epidemiol. 31, 1154–1159 (2010).

  28. 28.

    Perencevich, E. N. et al. Summer peaks in the incidences of Gram-negative bacterial infection among hospitalized patients. Infect. Control Hosp. Epidemiol. 29, 1124–1131 (2008).

  29. 29.

    Mermel, L. A., Machan, J. T., Parenteau, S., Brown, S. M. & Jones, K. Seasonality of MRSA infections. PLoS ONE 6, e17925 (2011).

  30. 30.

    Gautam, R. et al. Modeling the effect of seasonal variation in ambient temperature on the transmission dynamics of a pathogen with a free-living stage: example of Escherichia coli O157:H7 in a dairy herd. Prev. Vet. Med. 102, 10–21 (2011).

  31. 31.

    Levin, B. R. Minimizing potential resistance: a population dynamics view. Clin. Infect. Dis. 33, S161–S169 (2001).

  32. 32.

    IPCC Climate Change 2013: The Physical Science Basis (eds Stocker, T. F. et al.) (Cambridge Univ. Press, 2014).

  33. 33.

    Bruinsma, N. et al. Influence of population density on antibiotic resistance. J. Antimicrob. Chemother. 51, 385–390 (2003).

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D.R.M. is supported by a Canadian Institute for Health Research Fellowship Grant and the Clinician Scientist Program at the Department of Medicine, University of Toronto. J.S.B. is supported by the National Library of Medicine NIH R01 LM011965. Thank you to the developers and data analysts at HealthMap for their support. Thank you to M. Kramer for his thoughtful and insightful review and feedback.

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Author notes

  1. These authors contributed equally: Derek R. MacFadden and Sarah F. McGough.

  2. These authors jointly supervised this work: Mauricio Santillana and John S. Brownstein.


  1. Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada

    • Derek R. MacFadden
    •  & David Fisman
  2. Harvard Chan School of Public Health, Harvard University, Boston, MA, USA

    • Derek R. MacFadden
    •  & Sarah F. McGough
  3. Computational Epidemiology Group, Boston Children’s Hospital, Boston, MA, USA

    • Derek R. MacFadden
    • , Mauricio Santillana
    •  & John S. Brownstein
  4. Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA, USA

    • Sarah F. McGough
    • , Mauricio Santillana
    •  & John S. Brownstein
  5. Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA, USA

    • Mauricio Santillana
    •  & John S. Brownstein


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D.R.M., S.F.M. and M.S. contributed to the data analysis. All the authors (D.R.M., S.F.M., D.F., M.S. and J.S.B.) contributed to development of the manuscript, discussion and preparation of final versions. All the authors approved the final version of the manuscript.

Competing interests

The authors declare no competing interests.

Corresponding authors

Correspondence to Derek R. MacFadden or Mauricio Santillana or John S. Brownstein.

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  1. Supplementary Information

    Supplementary figures 1–8, Supplementary tables 1–4

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