Peer-reviewed article
Vaccination coverage in Italian children and antimicrobial resistance: an ecological analysis
Andrea Maugeri, Martina Barchitta, Antonella Agodi ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether vaccination coverage in Italian children is associated with lower rates of antimicrobial resistance (AMR) in the general population. Researchers analyzed data on childhood vaccinations, AMR proportions, and antibiotic use over two decades. They found that higher vaccination coverage, particularly for pertussis, diphtheria, tetanus, and polio vaccines, was associated with lower proportions of antibiotic-resistant bacteria in clinical samples. The authors caution that their ecological study design limits the strength of conclusions and call for further targeted research.
Key points
- Vaccination coverage for pertussis, diphtheria, and tetanus was inversely related to E. coli resistance to fluoroquinolones and third generation cephalosporins
- Higher polio vaccination coverage was associated with lower proportions of E. coli and K. pneumoniae resistant to third generation cephalosporins
- The relationship between vaccination coverage and AMR proportions was examined across multiple vaccine types, pathogens, and antimicrobials
- The analysis controlled for covariates including antibiotic use
- Authors acknowledge ecological study design limits the ability to draw causal conclusions
Limitations
This is an ecological analysis using population-level data, which cannot establish causal relationships or account for individual-level confounding factors. The authors note that further studies specifically designed to measure vaccination impact on AMR are needed.
Abstract
BACKGROUND: Although a general consensus that vaccines could be a complementary strategy against antimicrobial resistance (AMR), there is still the need for studies investigating the relationship between childhood vaccination coverage and AMR proportions in the overall population. METHODS: We performed an ecological analysis of available Italian data (vaccination coverages, AMR proportions, number of isolates tested, and antibiotic use) to evaluate the relationships between vaccination coverages in children and AMR proportions in the last 2 decades. RESULTS: After adjusting for covariates, we showed that AMR proportions decreased with increasing vaccination coverages, especially for some combinations of vaccines, pathogens, and antimicrobials. Vaccination coverages for pertussis, diphtheria, and tetanus were inversely related to proportions of E. coli resistant to fluoroquinolones and third generation cephalosporins, K. pneumoniae resistant to carbapenems and third generation cephalosporins, and P. aeruginosa resistant to piperacillin and tazobactam. Polio vaccination coverage was inversely related to proportions of E. coli and K. pneumoniae resistant to third generation cephalosporins. CONCLUSIONS: These results, however, should be interpreted cautiously due to the ecological nature of our analysis. For this reason, further studies designed ad hoc should be encouraged to measure the impact of increasing childhood vaccination coverage on AMR.