Increases in Antibiotic Resistance Linked to Poor Air Quality

Smoke coming out of smoke stacks, air pollution has been linked to an increase in antibiotic resistance.
“Antibiotic resistance is one of the fastest-growing threats to global health. It can affect people of any age in any country and is already killing 1.3 million people a year, according to estimates.”

The number one use for antibiotics is to treat and prevent bacterial infections. But what happens when the bacteria stop responding to antibiotics? This phenomenon is called antibiotic resistance, also known as antimicrobial resistance or AMR, and it occurs when pathogens like bacteria and fungus evolve and adapt to resist medicine, making them harder to treat. While this is not a new phenomenon, the current rate of antibiotic resistant bacteria has drastically increased and is predicted to continue without proper intervention.

Causes of Antibiotic Resistance

What is causing this unprecedented increase in antimicrobial resistance? Of course, the main drivers are still the misuse and overuse of antibiotics; however, a study recently published by The Lancet Planetary Health suggests that the exacerbation of this issue is linked to an increase in air pollution - specifically PM2.5. The study states, “ The major air pollutant, in the form of particulate matter (PM2.5), has been shown to contain diverse antibiotic-resistant bacteria and antibiotic-resistance genes…”

Pollution, which contains antibiotic resistant bacteria and genes, is able to catch a ride to heavily populated areas via air streams. “Air pollution is already the single largest environmental risk to public health,” according to The Guardian. “Long-term exposure to air pollution is associated with chronic conditions such as heart disease, asthma and lung cancer, reducing life expectancy.” Heightened air pollution, which is common globally especially in urban cities, not only increases the risk of inhaling these harmful pollutants and bacteria both indoors and outside, but it directly increases the risk of contracting respiratory-related illnesses or injuries.

Avenues for Spread

The Lancet study identified air as the direct pathway from which the bacteria came from. The study found that antibiotic resistant bacteria and genes can be found in wastewater, wildfires, farms, and hospitals where they are then inhaled or ingested. A burgeoning increase of pollution in urban areas poses an heightened risk of exposure to antibiotic resistant bacteria as, according to the American Lung Association’s 2023 State of the Air, “nearly 36% of Americans—119.6 million people—still live in places with failing grades for unhealthy levels of ozone or particle pollution.”

Exacerbating Factors

Factors that are linked to an increase in antibiotic resistant bacteria include poor drinking water, overprescription of antibiotics (specifically referring to the limited types available,) and overuse of antibiotics in livestock. According to Our World Data, one in four people do not have access to clean drinking water. Additionally, HealthDay found that “About 7.3 billion people globally are directly exposed to unsafe average annual PM2.5 levels.” With a large number of people experiencing unhealthy, contaminated air that potentially contains antibiotic resistance and a quarter of the population lacking access to clean water, the risk for coming in contact with these antimicrobial resistant bacteria and genes is exponentially increased.

Cost of Antimicrobial Resistance

There are a multitude of costs associated with antibiotic resistant infections: cost of medical treatment, loss of life, and welfare costs. In terms of welfare costs, infections that are antibiotic resistance are “estimated at $400 billion USD each year.” Health Affairs claims that treatment costs for these infections were significantly higher for patients 75 and older. Additionally, patients with multiple comorbidities received higher bills. On average older patients received bills that were “$1,102 higher than the costs among people younger than age eighteen.” Similarly, the estimated cost of treating bacterial infections among patients in fair or poor health was $2,060 higher than patients with excellent health. As for loss of life, nearly “23,000 Americans with these infections die each year.”

Current Impact of Antibiotic Resistance

The number of antibiotic resistant bacteria has increased alongside the rise in pollution globally. The Guardian reports that “with every 10% rise in air pollution linked with increases in antibiotic resistance of 1.1%.” At the current rate if there are no changes to policy or behavior, the study indicates that by 2050 antibiotic resistant levels could increase by 17% globally and the yearly death toll is estimated to reach 840,000.

“The harm caused by global air pollution has no borders…Therefore, the comprehensive control of global air pollution requires the coordinated actions of governments of all countries and the joint efforts of all humans.”
— The Lancet Planetary Health, Association between particulate matter (PM2.5) air pollution and clinical antibiotic resistance: a global analysis

Controlling Antibiotic Resistance

When discussing potential solutions for controlling exposure to antibiotic resistant bacteria, there are a few different avenues to consider. Because air pollution is the key vector that transports antimicrobial resistant genes and bacteria, improving air quality is a solution with high priority. The Lancet study suggested that controlling air pollution could also reduce the death toll and financial cost of treating antibiotic resistant infections. The lead author of The Lancet study, Professor Hong Chen of Zhejiang University in China, claims that the benefits of improving air quality “could be twofold, reduce harmful effects of poor air quality, but also combat the rise and spread of antibiotic resistant bacteria.”

How can we effectively tackle the issue of poor air quality? We can begin by listening to organizations like ASHRAE or the World Health Organization, both of whom have published standards relating to air quality and infection prevention. For example, the WHO’s air quality standards recommend no more than five μg/m3 of PM2.5. The Lancet study claims if the WHO’s five μg/m3 target is achieved by 2050, we can expect to see an estimated reduction in antibiotic resistance “by 16.8% and avoid 23.4% of premature deaths attributable to antibiotic resistance, equivalent to a saving of $640 billion.”

Beside achieving global air quality standards, which relies heavily on the cooperation of our global neighbors, there are steps that we can take to reduce the harmful outcomes associated with antibiotic resistant bacteria. According to News Medical, potential measures that can help achieve realistic goals “include doubling the current health expenditure, reducing current antibiotic use by at least 50%, achieving WHO-standard PM2.5 levels, and providing universal access to basic drinking water.”

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