The effect of greenness on ESKAPE pathogen reduction and its heterogeneity across global climate zones and urbanization gradient

Antibiotic resistance is a global health challenge, urgently requiring solutions from multi-disciplinary studies. Existing researches have pinpointed the potential of greenness as a nature-based solution to reduce pathogen abundance. Nevertheless, it remains unknown whether this efficacy extends to antibiotic-resistant pathogens, and furthermore, how this effect varies across global climate zones and urbanization gradient. Here, using 2875 samples worldwide, we examined the effect of Normalized Difference Vegetation Index (NDVI) on the abundance of ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens at the global scale, as well as in subgroups with samples of four different climate zones and urbanization statuses. Results showed that NDVI was significantly and negatively correlated with the total abundance of ESKAPE pathogens, but this effect was only consistent in the temperate and cold zones while insignificant in the others (tropical and arid zones). In addition, the effect size of NDVI on ESKAPE pathogen abundance followed a U-shape curve along urbanization gradient, with significant negative relationships occurring in suburban and moderately urbanized areas (urbanized land proportion between 30 % and 70 %). Our results brought insights into the importance of greenness as a spatial therapy against antibiotic-resistant pathogens, and also pinpointed the climate zones and urban areas where greenness could exert more efficient impact.