Association between particulate matter (PM)2·5 air pollution and clinical antibiotic resistance: a global analysis

Zhenchao Zhou; Xinyi Shuai; Zejun Lin; Xi Yu; Xiaoliang Ba; Mark A Holmes; Yonghong Xiao; Baojing Gu; Hong Chen

doi:10.1016/S2542-5196(23)00135-3

Association between particulate matter (PM)_2·5 air pollution and clinical antibiotic resistance: a global analysis

Lancet Planet Health. 2023 Aug;7(8):e649-e659. doi: 10.1016/S2542-5196(23)00135-3.

Authors

Zhenchao Zhou¹, Xinyi Shuai¹, Zejun Lin¹, Xi Yu¹, Xiaoliang Ba², Mark A Holmes², Yonghong Xiao³, Baojing Gu⁴, Hong Chen⁵

Affiliations

¹ College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, China.
² Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
³ State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
⁴ College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, China. Electronic address: bjgu@zju.edu.cn.
⁵ College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, China; Ministry of Education Key Laboratory of Environment Remediation and Ecological Health, Zhejiang University, Hangzhou, China; Zhejiang International Science and Technology Cooperation Base of Environmental Pollution and Ecological Health, Hangzhou, China. Electronic address: chen_hong@zju.edu.cn.

PMID: 37558346
DOI: 10.1016/S2542-5196(23)00135-3

Abstract

Background: Antibiotic resistance is an increasing global issue, causing millions of deaths worldwide every year. Particulate matter (PM)_2·5 has diverse elements of antibiotic resistance that increase its spread after inhalation. However, understanding of the contribution of PM_2·5 to global antibiotic resistance is poor. Through univariate and multivariable analysis, we aimed to present the first global estimates of antibiotic resistance and burden of premature deaths attributable to antibiotic resistance resulting from PM_2·5 pollution.

Methods: For this global analysis, data on multiple potential predictors (ie, air pollution, antibiotic use, sanitation services, economics, health expenditure, population, education, climate, year, and region) were collected in 116 countries from 2000 to 2018 to estimate the effect of PM_2·5 on antibiotic resistance via univariate and multivariable analysis. Data were obtained from ResistanceMap, European Centre for Disease Prevention and Control Surveillance Atlas (antimicrobial-resistance sources), and PLISA Health Information Platform for the Americas. Future global aggregate antibiotic resistance and premature mortality trends derived from PM_2·5 in different scenarios (eg, 50% reduced antibiotic use or PM_2·5 controlled to 5 μg/m³) were projected until 2050.

Findings: The final dataset included more than 11·5 million tested isolates. Raw antibiotic-resistance data included nine pathogens and 43 types of antibiotic agents. Significant correlations between PM_2·5 and antibiotic resistance were consistent globally in most antibiotic-resistant bacteria (R²=0·42-0·76, p<0·0001), and correlations have strengthened over time. Antibiotic resistance derived from PM_2·5 caused an estimated 0·48 (95% CI 0·34-0·60) million premature deaths and 18·2 (13·4-23·0) million years of life lost in 2018 worldwide, corresponding to an annual welfare loss of US$395 (290-500) billion due to premature deaths. The 5 μg/m³ target of concentration of PM_2·5 in the air quality guidelines set by WHO, if reached in 2050, was estimated to reduce antibiotic resistance by 16·8% (95% CI 15·3-18·3) and avoid 23·4% (21·2-25·6) of premature deaths attributable to antibiotic resistance, equivalent to a saving of $640 (580-671) billion.

Interpretation: This analysis is the first to describe the association between PM_2·5 and clinical antibiotic resistance globally. Results provide new pathways for antibiotic-resistance control from an environmental perspective.

Funding: National Natural Science Foundation of China, Fundamental Research Funds for the Central Universities, Zhejiang University Global Partnership Fund, and China Postdoctoral Science Foundation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollution* / adverse effects
Air Pollution* / analysis
China
Drug Resistance, Microbial
Humans
Mortality, Premature
Particulate Matter* / adverse effects
Particulate Matter* / analysis

Substances

Particulate Matter