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Rising air pollution levels may be linked to increased antibiotic resistance, according to new research published in The Lancet Planetary Health.
The study highlights the need to curb the level of pollution in the air in order to reduce deaths and economic costs stemming from antibiotic-resistant infections.
Indeed, in 2018, almost half a million premature deaths were linked to antibiotic resistance potentially resulting from air pollution, costing global economies and additional $395 billion.
Lead author Professor Hong Chen, of Zhejiang University, China, says the benefits of controlling air pollution will therefore be two-fold.
“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,” he said.
What causes antibiotic resistance?
Misuse and overuse of antibiotics are the main drivers of antibiotic resistance, but evidence suggests air pollution also contributes to the spread of antibiotic-resistant bacteria and resistance genes.
However, 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 globally.
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 percent living in low- and middle-income countries.
The authors therefore wanted to find out whether PM2.5 is a key factor driving global antibiotic resistance.
Relationship between air pollution and antibiotic resistance strengthened over time
To do this, they used data from 116 countries spanning nearly two decades (from 2000 to 2018). data on more than 11.5 million test isolates were included in the analysis, covering nine bacterial pathogens and 43 types of antibiotics.
Data on antibiotic usage, sanitation services, economics, health spend, population, education, climate and air pollution were used to investigate the influence of these factors on levels of antibiotic resistance.
The researchers found that 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.
Furthermore, this relationship has strengthened over time, with increases in air pollution levels coinciding with larger increases in antibiotic resistance in more recent years.
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 thought to be the countries where changes in PM2.5 have the greatest impact on premature death toll from antibiotic resistance.
PM2.5 a leading cause driving antibiotic resistance
The analysis therefore concluded 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 North Africa and western Asia, it accounts for 19% of changes to resistance levels.
With this in mind, the authors predict that if there are no changes to current policies on air pollution, by 2050, levels of antibiotic resistance worldwide could increase by 17%, killing around 840,000 people every year.
Increasing health spending, improving drinking water and reducing antibiotic usage would also help to reduce the level of antibiotic resistance, the authors write, but limiting PM2.5 was found to have the greatest effect.
Indeed, according to the World Health Organization, limiting PM2.5 to 5μg/m3 in the atmosphere could decrease global antibiotic resistance by 17% by 2050.