Setting up econometric ARIMA methodology to elucidate European Union nosocomial antimicrobial resistance rate trend evolution based on largest EU database

Abstract Background Infectious pathogens harboring cephalosporin or fluoroquinolones resistance constitute a serious hazard to human health. Objectives The aim of this study is to set up a methodology based on econometric analysis and largest European Union (EU) resistance database (EARS-Net) to model EU nosocomial antimicrobial resistance (AMR) and to detect tendency changes, steps or peaks. The contribution of legislation based on third generation cephalosporin (3GC) and fluoroquinolones (FQ) class referrals on EU resistance rate patterns is evaluated. Methods We studied 3GC and FQ resistance in nosocomial E. coli, K. pneumoniae and P. aeruginosa in at least 25 out of 30 EU countries (> 94% population coverage) weighted by their mean annual population between 2006 and 2016. Autoregressive and moving average integrated models (ARIMA) analysis inspired by Box-Jenkins methodology was thoroughly prepared to adjust series to a mathematic model to detect hypothetical changes in the general behavior. To the best of our knowledge, this is the first study using ARIMA with interventions to model overall EU nosocomial AMR data compiled in EARS-Net. Results and Conclusions Econometric ARIMA model statistically proved slowdowns and reversions in increase trend of nosocomial E. coli and K. pneumoniae resistance to 3GC and FQ, as well as in resistance of P. aeruginosa resistance to 3GC. P. aeruginosa resistance to FQ shows a descending slope. These brakes and decreased trends proved constitute noteworthy milestones in tackling AMR in Europe.