Air pollution by PM2.5 linked to rise in antibiotic resistance globally: Analysis

Study throws new light on spread of antimicrobial resistance through air, has relevance for all areas where air pollution is higher, says CSE

By Susan Chacko
Published: Thursday 17 August 2023
Globally, a 10 per cent increase in annual PM2.5 could lead to a 1.1 per cent increase in aggregate antibiotic resistance and 43,654 premature deaths, the paper published in Lancet Planetary Health found. Photo: iStock

A recent study has found links between fine particulate matter (PM2.5) air pollution and antibiotic resistance. Africa and Asia could face the largest increase in antibiotic resistance, the study published in journal Lancet Planetary Health said. 

The study presented the first global estimates of antibiotic resistance and burden of premature deaths attributable to antibiotic resistance resulting from PM2.5 pollution. Significant correlations between PM2.5 and antibiotic resistance were consistent globally in most antibiotic-resistant bacteria and correlations have strengthened over time.

Read more: Are antibiotic resistant bacteria the new global epidemic?

Air pollution is considered to be the world’s largest environmental health threat, accounting for seven million deaths around the world every year, according to the United Nations. 

Globally, a 10 per cent increase in annual PM2.5 could lead to a 1.1 per cent increase in aggregate antibiotic resistance and 43,654 premature deaths, the paper found. 

Saudi Arabia would have a three per cent increase in antibiotic resistance if PM 2.5 increases by 10 per cent, Niger would see a 2.9 per cent increase, United Arab Emirates a 2.6 per cent increase, Pakistan a 2.6 per cent increase, Nigeria a 2.5 per cent increase, India a 2.5 per cent increase, Cameroon a 2.2 per cent increase, Bahrain a 2.2 per cent increase and China a 2.1 per cent increase. 

China and India could be the countries where changes in PM2.5 have the largest effect on premature deaths attributable to antibiotic resistance due to their large populations. 

It is important to understand all pathways adding up to antimicrobial resistance (AMR), said Rajeshwari Sinha, programme manager, sustainable food systems programme, Delhi-based think tank Centre for Science and Environment.

“This study adds to the growing evidence base and throws more light on a new route of AMR spread through the air. It has relevance for all areas where air pollution is higher,” she said.

Antibiotic resistance resulting from PM2.5 caused an estimated 480,000 premature deaths in 2018 and 18.19 million years of life lost (YLL) worldwide in 2018, the paper found. This corresponded with an annual welfare loss of $395 billion due to premature deaths, said the study.

“The five microgramme per cubic metre (μg/m3) target of concentration of PM2.5 in the air quality guidelines set by the World Health Organization (WHO), if reached in 2050, was estimated to reduce antibiotic resistance by 16.8 per cent and avoid 23.4 per cent of premature deaths attributable to antibiotic resistance, equivalent to a saving of $640 billion,” according to the study led by Zhenchao Zhou, College of Environmental and Resource Sciences, Zhejiang University, China.

The analysis took data on multiple potential predictors like air pollution, antibiotic use, health expenditure and economics were collected in 116 countries from 2000 to 2018 to estimate the effect of PM2.5 on antibiotic resistance. 

Read more: Collaboration, policy, regulatory changes needed to fight antimicrobial resistance: Report

Benefit to global health

The researchers analysed a set of scenarios until 2050. In a baseline scenario in which no policies were applied to control air pollution, antibiotic resistance increased by 17 per cent and annual deaths attributable to antibiotic resistance increased by 56.4 per cent by 2050 globally, the study cautioned. 

In the same baseline scenario, the most substantial increase in premature mortality attributable to antibiotic resistance was seen in sub-Saharan Africa, whereas moderate decreases in premature mortality were seen in east Asia and southeast Asia.

The number of deaths attributable to antibiotic resistance derived from PM2.5 could increase to 840,000 in 2050 in the baseline scenario, the Lancet analysis predicted. 

In other scenarios, such as increasing current health expenditures, controlling PM2.5, improving drinking-water services and reducing antibiotic use, antibiotic resistance could be substantially reduced.

Compared with the baseline scenario, the welfare policy for controlling PM2.5 to 5 μg/m3 could decrease global antibiotic resistance by 16.8 per cent and prevent deaths attributable to antibiotic resistance by approximately 23.4 per cent by 2050. This would correspond to an annual welfare of $640 billion benefited from reduced premature deaths.

In the third multivariate scenario, global antibiotic resistance could be decreased by 50 per cent and deaths attributable to antibiotic resistance could be reduced by 54.5 per cent by 2050 compared with the baseline scenario. 

Experts at a webinar conducted by CSE in July 2023 highlighted how the burden of antibiotic resistance is increasing and existing antibiotics are becoming ineffective. Most antibiotics developed over the last decade are not novel enough and insufficient to treat multi-drug resistant bacteria.

A study published in Nature journal, May 17, 2023 by Bijay Halder & et al found that during 2018-2021, India witnessed the highest levels of human-induced air pollution. The period saw a surge in air pollution owing to the development of transportation, industrial power plants, green space dynamics and unplanned urbanisation in the country, noted the study.

Read more: Indoor air pollution can slow down brain development in infants: Study

WHO ambient air quality database 2022 provided clear evidence of the damage that air pollution inflicts on human health at even lower concentrations than previously recognised. 

The guidelines recommend new air quality levels to protect the health of populations. Moreover, reducing the levels of key air pollutants will also contribute to slowing climate change. 

Pollutants for which new guidelines for annual mean values have been set are PM2.5, with a guideline value half the previous one; PM10, which is decreased by 25 per cent and for nitrogen dioxide, which is four times lower than the previous guideline.

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