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JAC Advance Access originally published online on January 6, 2003
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Journal of Antimicrobial Chemotherapy (2003) 51, 385-390
© 2003 The British Society for Antimicrobial Chemotherapy

Influence of population density on antibiotic resistance

N. Bruinsma1, J. M. Hutchinson2, A. E. van den Bogaard1, H. Giamarellou3, J. Degener4 and E. E. Stobberingh1,*

1 Department of Medical Microbiology, University Maastricht, PO Box 5800, 6202 AZ Maastricht; 4 Department of Medical Microbiology, University Hospital Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands; 2 Discipline of Laboratory Medicine (Medical Microbiology), Faculty of Medicine, Memorial University of Newfoundland, Canada; 3 4th Department of Internal Medicine, University of Athens, Athens, Greece

Received 19 June 2002; returned 17 September 2002; revised 24 October 2002; accepted 4 November 2002

Antibiotic consumption and population density as a measure of crowding in the community were related to the prevalence of antibiotic resistance of three cities in three different countries: St Johns in Newfoundland (Canada), Athens in Greece and Groningen in The Netherlands. Antibiotic consumption was expressed in DDD (defined daily dose), as DID (DDD/1000 inhabitants/day) and as DSD (DDD/km2). The prevalence of antibiotic-resistant Escherichia coli and enterococci was determined in faecal samples of healthy volunteers. In both Newfoundland (28 DID) and Greece (29 DID) the overall consumption of antibiotics was more than three times higher compared with that of The Netherlands (9 DID). The lowest prevalence of resistant E. coli against the majority of antibiotics tested was found for the samples from Newfoundland and was significant (P < 0.05) for cefazolin, oxytetracycline and trimethoprim. A poor correlation between the number of DID and the prevalence of resistance was observed [the Pearson correlation coefficient (Pcc) ranged between –0.93 and 0.87]. However, when population density was taken into consideration and antibiotic consumption was expressed in DSD, a strong correlation was observed (and Pcc ranged between 0.86 and 1.00). This study suggests that population density is an important factor in the development of antibiotic resistance and warrants special attention as a factor in resistance epidemiology.

Keywords: population density, antibiotic resistance, antibiotic use, E. coli, enterococci

* Corresponding author. Tel: +31-43-3874644; Fax: +31-43-3876643; E-mail: est{at}lmib.azm.nl


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