There is a strong link between air pollution and antibiotic resistance, as demonstrated by the results of an 18-year-old study. Published in the Lancet Planetary Health journal, the study indicates that increased air pollution is potentially linked to a higher risk of antibiotic resistance across the globe. This is the first time such a link has been established, highlighting the pressing need for controlling air pollution.
The study titled ‘Association between particulate matter (PM 2.5) air pollution and clinical antibiotic resistance: A global analysis’, conducted between 2000-2018, also indicates that the relationship between the two has strengthened over time, with increases in air pollution levels coinciding with increases in antibiotic resistance in more recent years.
The study also warns that if no changes are made to the existing air pollution policies, global antibiotic resistance will increase by 17 per cent by 2050.
Antibiotic resistance and PM 2.5
The researchers aimed at presenting the first global estimates of antibiotic resistance and the burden of premature deaths attributable to antibiotic resistance resulting from PM 2.5 (fine particulate matter that is 2.5 microns or less in diameter) pollution.
The research team analysed the data from 116 countries on multiple predictors such as air pollution, antibiotic use, sanitation services, economics, health expenditure, population, education, climate, year and region. “More than 11.5 million test data points were included in the analysis, covering nine bacterial pathogens and 43 types of antibiotics. Data on antibiotic usage, sanitation services, economics, health spending, population, education, climate and air pollution was used to investigate the influence of these factors on levels of antibiotic resistance,” the press release said.
According to the lead author, professor Hong Chen, of Zhejiang University, China, “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, but it could also play a major role in combatting the rise and spread of antibiotic-resistant bacteria.”
The research highlights that antibiotic resistance increases with PM 2.5. Every one per cent rise in air pollution causes an increase in antibiotic resistance between 0.5 and 1.9 per cent, depending on the pathogen. “The association has strengthened over time, with changes in PM 2.5 levels leading to larger increases in antibiotic resistance in more recent years,” the study said.
Controlling pollution could reduce antibiotic resistance
As per the research, the highest levels of antibiotic resistance were found in North Africa, the Middle East and South Asia, whereas the levels in Europe and North America were low. “Due to their large populations, China and India are thought to be the countries where changes in PM 2.5 have the greatest impact on premature death [death before the age of 50] toll from antibiotic resistance,” the researchers said.
Antibiotic resistance dissemination can occur in many ways. According to the study, the pathway of antibiotic resistance dissemination involves waste generated from hospitals, pharmaceutical factories and communities entering wastewater treating plants that further reach the water resources. The other ways include the dissemination of aerosol through the air and other particulate matter through the soil.
Curbing levels of air pollution could help reduce antibiotic resistance, Lancet Planetary Health said in its tweet.
The research has led to discussions in the medical community. Speaking to Happiest Health, Dr Satynarayana Mysore, HOD and consultant, pulmonology and lung transplant, Manipal Hospitals, Bengaluru, said that we are too quick to draw parallels between air pollution and antibiotic resistance. He points out that it is common knowledge that air quality can cause an increase in asthma, COPD and the like, thus necessitating the need to use antibiotics. “Increased use of antibiotics itself is to be frowned upon. A direct link between air pollution, poor air quality index and antibiotic resistance is a long shot at this point in time,” says Dr Mysore.
According to Dr Paparao Nadakuduru, infectious disease specialist, Citizen’s Hospital, Hyderabad, the study highlights the need for the judicious use of antibiotics. “While we are battling against multidrug-resistant bacteria, the number of new antibiotics produced has not increased. There is an imbalance between drug-resistant bacteria and the antibiotics that are available. This shows the pressing need for curbing air pollution and the overuse of antibiotics,” said Dr Nadakuduru, cautioning against the over-the-counter purchase and self-medication of antibiotics which can result in antibiotic resistance.
As per a recent study, there is a correlation between air pollution and antimicrobial resistance. The study conducted for 18 years shows that PM 2.5 contains antibiotic-resistant bacteria which may be inhaled directly by humans. The study also warns that if no changes are made to the existing air pollution policies, global antibiotic resistance will increase by 17 per cent by 2050.