{
  "abstract": "Background Antimicrobial resistance (AMR) is an escalating global health crisis being worsened by climate change. Studies of temperature–AMR associations remain limited by geographic scope, time frames and linear approaches. We aimed to identify temperature thresholds where AMR dynamics shift across pathogen–drug combinations, periods and socioeconomic contexts.Methods We analysed data from 56 countries and territories over 24 years (1999–2022), focusing on six WHO-designated ‘critical’ antibiotic-resistant pathogens. Using segmented regression models with mean ambient temperature as the primary independent variable, we divided the study period into three intervals (1999–2006, 2007–2014, 2015–2022) and incorporated 16 socioeconomic and environmental covariates. Model robustness was validated through bootstrap cross-validation with 1000 resamples.Findings We identified distinct temperature association thresholds for each pathogen–drug combination (5.7°C–18.4°C). Below these thresholds, resistance rates consistently decreased with rising temperatures; above thresholds, responses varied by phenotype and time period. For third-generation cephalosporin-resistant Escherichia coli, each 1°C rise above 16.5°C corresponded to a 0.46% increase (95% CI 0.28% to 0.65%; p<0.001) during 1999–2006, a 0.11% decrease (95% CI −0.17% to −0.06%; p<0.001) during 2007–2014 and a 0.18% increase (95% CI 0.11% to 0.25%; p<0.001) during 2015–2022. The Corruption Perception Index showed consistent negative associations with resistance rates, particularly for carbapenem-resistant Acinetobacter baumannii (β=−1.40, p<0.001).Interpretation Phenotype-specific temperature association thresholds provide descriptive, hypothesis-generating reference points for understanding how AMR burden varies along the global temperature gradient. The observed temporal heterogeneity suggests complex patterns requiring long-term monitoring and climate-adaptive AMR control strategies considering both phenotype-specific temperature sensitivities and socioeconomic contexts.",
  "authors": [
    {
      "affiliations": [
        "School of Public Health, Sun Yat-sen University, Guangzhou, China"
      ],
      "name": "Ruonan Wang"
    },
    {
      "affiliations": [
        "School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Chaojie Liu"
    },
    {
      "affiliations": [
        "Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China"
      ],
      "name": "Weibin Li"
    },
    {
      "affiliations": [
        "School of Public Health, Sun Yat-sen University, Guangzhou, China",
        "School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China"
      ],
      "name": "Xinyi Yang"
    },
    {
      "affiliations": [
        "School of Public Health, Sun Yat-sen University, Guangzhou, China"
      ],
      "name": "Haohai Xia"
    },
    {
      "affiliations": [
        "School of Public Health, Sun Yat-sen University, Guangzhou, China"
      ],
      "name": "Xiying Li"
    },
    {
      "affiliations": [
        "School of Public Health, Sun Yat-sen University, Guangzhou, China"
      ],
      "name": "Shengyue Qiu"
    },
    {
      "affiliations": [
        "School of Public Health, Sun Yat-sen University, Guangzhou, China"
      ],
      "name": "Zishu Ma"
    },
    {
      "affiliations": [
        "School of Public Health, Sun Yat-sen University, Guangzhou, China"
      ],
      "name": "Fanqian Meng"
    },
    {
      "affiliations": [
        "School of Public Health, The University of Hong Kong, Hong Kong SAR, China"
      ],
      "name": "Shanquan Chen"
    },
    {
      "affiliations": [
        "School of Public Health, Sun Yat-sen University, Guangzhou, China"
      ],
      "name": "Yuewei Liu"
    },
    {
      "affiliations": [
        "National School of Development, Peking University, Beijing, China",
        "Institute for Global Health and Development, Peking University, Beijing, China"
      ],
      "name": "Gordon G Liu"
    },
    {
      "affiliations": [
        "Vanke School of Public Health, Tsinghua University, Beijing, China"
      ],
      "name": "Cunrui Huang"
    },
    {
      "affiliations": [
        "School of Political Science and Public Administration, Wuhan University, Wuhan, China"
      ],
      "name": "Qiang Yao"
    },
    {
      "affiliations": [
        "School of Politics and Public Administration, South China Normal University, Guangzhou, China",
        "Oxford School of Global and Area Studies, University of Oxford, Oxford, UK"
      ],
      "name": "Mingli Xu"
    },
    {
      "affiliations": [
        "School of Public Health, Sun Yat-sen University, Guangzhou, China",
        "Institute for Global Health and Development, Peking University, Beijing, China",
        "Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China",
        "Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Lianping Yang"
    }
  ],
  "title": "Ambient temperature variations and antimicrobial resistance: a multicountry analysis of non-linear relationships and temperature thresholds",
  "uid": "5a899629-4ac4-56bc-bb5d-a3b8ab36b9eb"
}