Abstract / Summary
Antibiotic resistance (ABR) is a global threat, yet its dynamics strongly vary across countries. Drivers of such heterogeneity remain unclear, limiting efforts to mitigate emergence and worldwide spread of multi-resistant clones. We developed a mechanistic modeling framework to analyze extended-spectrum {beta}-lactamase-producing Escherichia coli (ESBL-EC) dynamics globally accounting for antibiotic consumption and international mobility. Calibrated with data from 39 countries (2006-2019), the model is used to explore the global dissemination of potential emerging multi-resistant clones, like carbapenem-resistant E. coli (CR-EC). The model estimated heterogeneous within-country transmission rates and an excess risk of ABR acquisition under antibiotics of 9.83 (95%CrI:9.78-9.89). Simulations of potential CR-EC dissemination showed that mobility patterns drive early resistance dynamics, while long-term dynamics are mostly predicted by within-country transmission and antibiotic use. Our findings suggest that preventing introduction at the country-level is key to mitigate emerging threats but reducing within-country transmission and selection pressure is fundamental to avoid fixation.