Agricultural Pesticide Exposure and Antimicrobial Resistance in Escherichia coli Across 28 European Countries: A Panel and Spatial Data Analysis

Antimicrobial resistance (AMR) is a growing global health threat, and agricultural pesticide exposure has been proposed as an environmental driver of resistance alongside antibiotic consumption. However, long-term, multi-country evidence linking pesticide use to AMR in Escherichia coli remains limited. Panel data analysis was applied to data from 28 European countries between 2013 and 2023 to examine lagged associations between agricultural pesticide use and E. coli resistance to fluoroquinolones, third-generation cephalosporins, aminoglycosides, and aminopenicillins, alongside spatial analysis of resistance distribution. Country-level panel data on E. coli resistance, antibiotic consumption, and pesticide use per cultivated area were compiled for 28 European countries, except for the aminopenicillin resistance model, for which Sweden was excluded owing to insufficient longitudinal data, yielding a 27-country panel for that indicator. Four random-effects generalized least squares (GLS) panel regression models were constructed for each resistance indicator, incorporating same-year and one-, two-, and three-year lagged pesticide use, adjusted for the corresponding antibiotic consumption. Global Moran’s I and Local Indicators of Spatial Association (LISA) analyses assessed spatial autocorrelation and clustering of resistance across countries. Pesticide use was significantly and positively associated only with fluoroquinolone resistance at a three-year lag; no significant associations were found for third-generation cephalosporin, aminoglycoside, or aminopenicillin resistance at any lag. Antibiotic consumption was consistently and positively associated with resistance across all models. All four resistance indicators showed statistically significant positive spatial autocorrelation, with persistent high-resistance clusters in Southeast Europe and low-resistance clusters in Northern Europe. Antibiotic consumption remains the dominant determinant of E. coli resistance, whereas pesticide use shows only a delayed, class-specific association restricted to fluoroquinolone resistance.