Increasing air pollution could be linked to a higher risk of antibiotic resistance worldwide, and hence, reducing air pollution levels can help decrease antibiotic resistance. The relationship between increased air pollution and higher antibiotic resistance risk has strengthened over time, especially in more recent years, according to a study published August 8, 2023, in The Lancet Planetary Health journal. Since reducing air pollution could curb antibiotic resistance risk, deaths and economic costs associated with infections arising from antibiotic resistance will also be decreased.
Despite the fact that air is being recognised as a direct pathway and prime vector for spreading antibiotic resistance, not much data is available on the different mechanisms through which antibiotic resistant genes are circulated through air pollution. Hospitals, farms and sewage-treatment facilities are potential pathways for disseminating antibiotic resistance, and emit and spread antibiotic resistance particles through the air.
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Role of PM2.5 air pollution in increasing antibiotic resistance
The main reasons why antibiotic resistance occurs are misuse and overuse of antibiotics. Now, researchers have found evidence that air pollution also leads to the spread of antibiotic-resistant bacteria and resistance genes. This is because until now, data on the influence of PM2.5 air pollution on global antibiotic resistance was limited. PM2.5 is made up of particles 30 times smaller than the width of a human hair, is spread through road transport, wood burning, industrial processes, and road transport, and impacts 7.3 billion people globally because they are directly exposed to unsafe average annual PM2.5 levels. Of these, 80 per cent live in low- and middle-income countries.
In order to find out if PM2.5 is a primary factor driving global antibiotic resistance, researchers involved in the new study used data from 116 countries from 2000 to 2018, and created an extensive dataset. They covered nine bacterial pathogens and 43 types of antibiotics. There were a total of 11.5 million test isolates.
The researchers analysed the influence of factors such as antibiotic usage, economics, population, climate, sanitation services, health expenditure, education, and air pollution on antibiotic resistance levels. They collected data from the World Health Organization, the World Bank, the European Environment Agency, and surveillance databases.
As PM2.5 pollution increases, antibiotic resistance rises, the study found.
Statistics of the link between air pollution and antibiotic resistance
Every one per cent rise in air pollution is linked with increases in antibiotic resistance between 0.5 and 1.9 per cent, depending on the pathogen. Over time, the association has strengthened. In recent years, changes in PM2.5 levels led to higher increases in antibiotic resistance.
According to the study, China and India are believed to be the countries where changes in PM2.5 have the largest impact on premature death toll from antibiotic resistance because these nations have large populations.
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About 4,80,000 premature deaths that occurred in 2018 have been linked to antibiotic resistance resulting from air pollution.
PM2.5 accounts for 11 per cent of changes in average antibiotic resistance levels around the world. In north Africa and western Asia, PM2.5 accounts for 19 per cent of changes to antibiotic resistance levels.
If no changes to current policies in air pollution are made, the levels of antibiotic resistance worldwide could increase by 17 per cent by 2050, models suggest. The annual premature death toll linked with antibiotic resistance resulting from air pollution would increase to 8,40,000. The effect would be most pronounced in sub-Saharan Africa.
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How can antibiotic resistance levels be reduced?
By increasing health spending, improving drinking water, controlling air pollution, and reducing antibiotic usage, the level of antibiotic resistance could be reduced to a great extent, the authors suggested.
Global antibiotic resistance could be decreased by 17 per cent by 2050 if PM2.5 is limited to five micrograms per cubic metres, the WHO recommends. If this policy is implemented, premature deaths linked to antibiotic resistance could be reduced by 23 per cent.
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In a Lancet statement, Professor Hong Chen, the lead author on the paper, said antibiotic resistance and air pollution are each in their own right among the greatest threats to global health, and until now, researchers did not have a clear picture of the possible links between the two. However, the new work suggests the benefits of controlling air pollution could be two-fold.
This is because not only would controlling air pollution reduce the harmful effects of poor air quality, but could also play a major role in combating the rise and spread of antibiotic-resistant bacteria.
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Limitations to the study
Some of the limitations to the study include the fact that there is a lack of data in some countries, especially low- and middle-income countries. Since these are the countries most affected by antibiotic resistance, a lack of data from these countries may affect the overall analysis.
Also, the researchers believe that future research should focus on investigating the underlying mechanism of how air pollutants and other factors affect antibiotic resistance.
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