The Lancet Planetary Health has published a comprehensive global analysis indicating a potential link between rising air pollution and increased antibiotic resistance.
Examining data from 116 countries between 2000 and 2018, the study highlights a correlation between elevated levels of air pollution and a surge in antibiotic resistance. Regions such as North Africa, the Middle East, and South Asia display the highest antibiotic resistance rates, whereas Europe and North America report the lowest.
The study’s findings suggest a worrying relationship between air pollution and antibiotic resistance, with nearly half a million premature deaths in 2018 possibly attributed to antibiotic resistance fueled by air pollution. This scenario incurs an additional cost of $395 billion on global economies.
Moreover, modeling prospective scenarios reveals the potential benefits of adhering to World Health Organization air quality guidelines by 2050. Achieving this target could potentially lower antibiotic resistance by 17% and prevent 23% of related premature deaths. Such measures could result in annual economic savings of $640 billion.
Although the primary drivers of antibiotic resistance are antibiotic misuse and overuse, emerging evidence indicates that particulate matter PM2.5, a component of air pollution, could harbor antibiotic-resistant bacteria and resistance genes. These particles might transfer between environments and be inhaled by humans. Further research is required to fully understand these pathways.
The analysis underscores that curtailing harmful air pollution could have a substantial impact on reducing antibiotic resistance. By addressing air pollution, not only could the adverse effects of poor air quality be mitigated, but a potential key contributor to the rise and spread of antibiotic-resistant bacteria could be tackled.
Lead author Professor Hong Chen from Zhejiang University, China, emphasized the significance of the study’s findings in the context of global health threats. Professor Chen stated that controlling air pollution holds the potential to simultaneously combat poor air quality and antibiotic resistance, offering a two-fold advantage.
“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 Chen.
While antibiotics’ overuse and misuse are undeniable drivers of resistance, the study raises concerns that air pollution could contribute to the dissemination of antibiotic-resistant bacteria and genes. Particulate matter PM2.5, characterized by particles much smaller than a human hair, constitutes a component of air pollution. It is sourced from various activities such as industrial processes, road transport, and domestic fuel burning.
The research is based on an extensive dataset incorporating data from 116 countries over the years 2000 to 2018. This dataset encompasses over 11.5 million test isolates, encompassing nine bacterial pathogens and 43 antibiotic types. Variables such as antibiotic usage, sanitation services, economics, health spending, population, education, climate, and air pollution were analyzed to assess their impact on antibiotic resistance levels.
The study reveals a direct relationship between antibiotic resistance and PM2.5 air pollution. A 1% increase in air pollution was associated with a corresponding increase in antibiotic resistance, depending on the specific pathogen. Importantly, the strength of this association has grown over time, with recent years witnessing larger increases in antibiotic resistance in tandem with rising air pollution levels.
The findings further indicate that antibiotic resistance resulting from air pollution caused an estimated 480,000 premature deaths in 2018. This, in turn, incurred additional economic costs of $395 billion.
Modeling various scenarios underscores the potential positive outcomes of controlling air pollution. Should countries adhere to the WHO’s recommendation to limit PM2.5 to 5 μg/m3 by 2050, global antibiotic resistance could decrease by 17%. This reduction could prevent 23% of antibiotic resistance-linked premature deaths, resulting in annual economic savings of $640 billion.
Despite some limitations, such as the lack of data from low- and middle-income countries most affected by antibiotic resistance, the study underscores the urgent need to address air pollution to counteract the rise of antibiotic resistance.