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 genes

Curbing levels of harmful air pollution could not only help reduce antibiotic resistance, it could also reduce deaths and economic costs stemming from antibiotic-resistant infections, according to the first in-depth global analysis of possible links between the two, published in The Lancet Planetary Health journal.

The analysis shows antibiotic resistance resulting from air pollution is linked to an estimated 480,000 premature deaths in 2018 in addition to an economic cost of $395 billion.

Analysis of data across 116 countries between 2000 and 2018 indicates rising air pollution levels correlate with increased antibiotic resistance. North Africa, the Middle East and South Asia have the highest levels of antibiotic resistance, while Europe and North America have the lowest.
Almost half a million premature deaths in 2018 were linked to antibiotic resistance potentially resulting from air pollution, costing global economies an additional $395 billion.
Modelling of possible future scenarios suggests meeting World Health Organization air quality guidelines by 2050 could reduce antibiotic resistance by 17% and prevent 23% of associated premature deaths. This would deliver annual economic savings of $640 billion.
Although the misuse and overuse of antibiotics are the main drivers of antibiotic resistance, evidence suggests that particulate matter PM2.5 can contain antibiotic-resistant bacteria and resistance genes, which may be transferred between environments and inhaled directly by humans. However, further research is needed to understand these pathways.

The authors’ modeling 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 percent. The annual premature death toll linked to antibiotic resistance would rise to around 840,000, with the greatest increases in sub-Saharan Africa.

The analysis indicates that increased air pollution is potentially linked with a higher risk of antibiotic resistance across global regions. It also shows 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.

Although air is recognised as being a key vector for disseminating antibiotic resistance, there is limited quantitative data that antibiotic resistant genes are carried via air pollution. Some sites that potentially emit and spread antibiotic resistant particles through the air and across distances include hospitals, farms, and sewage-treatment facilities..

“Antibiotic resistance and air pollution are each in their own right among the greatest threats to global health,” lead author Professor Hong Chen, of Zhejiang University, China, said. “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.”

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.

In other scenarios like 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 – of limiting PM2.5 to 5 μg/m3 in the atmosphere could decrease global antibiotic resistance by 17 percent by 2050. This policy could lead to a 23 percent reduction in premature deaths (630,000 fewer deaths) linked to antibiotic resistance, and lead to annual economic savings of $640 billion.

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