Antibiotic resistance may be linked to rising air pollution: Lancet study
Recent findings indicate 7.3 billion people globally are directly exposed to unsafe average annual PM2.5 levels, with 80 % iving in low- and middle-income countries
The increasing incidence of antibiotic resistance may be linked to rising air pollution according to the first in-depth global analysis of the issue published in The Lancet Planetary Health journal on Monday.
Although the main drivers of such resistance remain the misuse and overuse of antibiotics, particulate matter, especially, PM2.5 (that with a diameter of less than 2.5 microns) can contain antibiotic-resistant bacteria and resistance genes, which may be transferred and inhaled directly by humans, according to the nine authors, eight of whom are from Zhejiang University in China; and one is from the department of veterinary medicine, University of Cambridge, UK.
The report said that due to their large populations, India and China may be regions where changes in PM2.5 have the largest effect on premature deaths attributable to antibiotic resistance. In fact, a 10% increase in annual PM2.5 in India could lead to a 2.5% increase in aggregate antibiotic resistance, and nearly 4% premature deaths.
Almost half a million premature deaths in 2018 were linked to antibiotic resistance potentially resulting from air pollution, they added, and curbing levels of harmful air pollution could help reduce antibiotic resistance.
“The analysis indicates that increased air pollution is potentially linked with a higher risk of antibiotic resistance across global regions. It also indicates that the relationship between the two has strengthened over time, with increases in air pollution levels coinciding with larger increases in antibiotic resistance in more recent years,” they wrote in the paper titled “Association between PM2.5 air pollution and clinical antibiotic resistance: A global analysis”.
Until now, there was limited data on how much influence PM2.5 air pollution – which is made up of particles 30 times smaller than the width of a human hair – has on antibiotic resistance.
Sources of PM2.5 include industrial processes, road transport, and domestic coal and wood burning.
Recent findings indicate 7.3 billion people globally are directly exposed to unsafe average annual PM2.5 levels, with 80 % iving in low- and middle-income countries, said the authors.
“Antibiotic resistance and air pollution are each in their own right among the greatest threats to global health. Until now, we didn’t have a clear picture of the possible links between the two, but this work suggests the benefits of controlling air pollution could be two-fold: not only will it reduce the harmful effects of poor air quality, it could also play a major role in combatting the rise and spread of antibiotic-resistant bacteria,” they added.
Antimicrobial resistance is the trend of resistance of key pathogens to the critically important antimicrobials or antibiotics. There is another sections of microbes that are termed superbugs, which means these are Carbapenem resistant. Carbapenem is a class of antibiotics usually reserved for known or suspected multidrug-resistant bacterial infections.
The findings indicate antibiotic resistance increases with PM2.5, with every 1% rise in air pollution linked with increases in antibiotic resistance of between 0.5% and 1.9%, depending on the pathogen. The association has strengthened over time, with changes in PM2.5 levels leading to larger increases in antibiotic resistance in more recent years, the authors point out.
“Antibiotic resistance and air pollution are each in their own right among the greatest threats to global health. Until now, we didn’t have a clear picture of the possible links between the two, but this work suggests the benefits of controlling air pollution could be two-fold: not only will it reduce the harmful effects of poor air quality, it could also play a major role in combatting the rise and spread of antibiotic-resistant bacteria,” said the study’s lead author professor Hong Chen, Zhejiang University.
The highest levels of antibiotic resistance are found in North Africa, the Middle East and South Asia, while levels in Europe and North America are low. Due to their large populations, China, and India are believed to be the countries where changes in PM2.5 have the greatest impact on premature death toll from antibiotic resistance.
“The analysis suggests that PM2.5 is one of the leading factors driving antibiotic resistance, accounting for 11% of changes in average resistance levels around the world. In comparison, health spending accounts for 10% of changes, while drinking water services make up 3%. North Africa and western Asia are the regions where PM2.5 has the greatest impact on antibiotic resistance, where it accounts for 19% of changes to resistance levels,”the authors wrote.
The analysis also indicates antibiotic resistance resulting from air pollution is linked to an estimated 480,000 premature deaths in 2018, and additional economic costs of $395 billion.
The authors’ modelling of possible future scenarios indicates that if there were no changes to current policies on air pollution, by 2050, levels of antibiotic resistance worldwide could increase by 17%. The annual premature death toll linked to antibiotic resistance would rise to around 840,000, with the greatest increases in sub-Saharan Africa.
However, in other scenarios, such as increasing health spending, controlling air pollution, improving drinking water and reducing antibiotic usage, the level of antibiotic resistance could be greatly reduced.
“For example, implementing a policy – recommended by the World Health Organization (WHO) – of limiting PM2.5 to 5 μg/m3 in the atmosphere could decrease global antibiotic resistance by 17% by 2050. This policy could lead to a 23% reduction in premature deaths (630,000 fewer deaths) linked to antibiotic resistance, and lead to annual economic savings of $640 billion,” the authors said.