Antibiotic resistance is a significant public health threat, leading to an estimated 700,000 premature deaths globally each year. Though this is mostly attributed to the widespread overprescription of antibiotics, other factors contribute to the increasing rates of antimicrobial resistance.
A study published in the Lancet Planetary Health in August found a potential link between antimicrobial resistance and air pollution, specifically fine particulate matter. In this article, Camfil’s air quality experts explain why antimicrobial resistance is so harmful, and how air pollution may contribute to its rising presence.
What is Antibiotic Resistance and Why Does It Matter?
Antibiotic, or anti-microbial, resistance is the process of pathogens (bacteria, fungi, and viruses) becoming less susceptible to the medications and treatments we use against them. Pathogens reproduce quickly, and viruses and bacteria are single-celled organisms, which means that the process of evolution can be observed in extremely short periods of time compared to larger organisms.
Genetic mutations, most of which happen due to random errors, cause some individual pathogens to develop attributes that may be benign (there is no effect on survival), negative (the pathogen is less likely to survive), or positive (the pathogen is more likely to survive) in relation to different environmental factors, known as selection pressures. Furthermore, all bacteria and viruses and most species of fungi reproduce asexually, meaning that, technically, only one has to survive to form a new colony. As the process repeats, strains of pathogens become stronger and more adapted to the stressors in their environment.
Antibiotics act as a selection pressure for bacteria, and prescribing or using antibiotics when it isn’t necessary speeds up the process of adaptation. The result of antimicrobial resistance is strains of pathogens that cannot be killed with the medications typically used to do so, which leads to infections and illnesses that cannot be treated. Healthy immune systems may be able to take care of some of these pathogens, while others may be fatal.
There are many bacterial infections that are easily treatable with antibiotics, but can be fatal or cause permanent damage if left untreated for too long; syphilis, leprosy, and diphtheria are a few examples. While these particular infections were not examined in this study, their effects illustrate how important it is to have effective treatments against bacterial infections in an era where antibiotic resistance is outpacing how quickly new antibiotics can be developed. This is especially important for vulnerable groups, such as children, the elderly, and the immunocompromised.
Study Links Air Pollution to Antimicrobial Resistance
Researchers used data from 116 countries on antibiotic resistance to specific treatments, totaling 11.5 million samples, as well as air pollution monitoring data collected between 2000 and 2018. They focused on 43 different types of antibiotics and the following pathogens:
- Acinetobacter baumannii, a highly-resistant bacteria that frequently causes hospital-acquired infections.
- Klebsiella pneumoniae, a bacteria that lives in human gut biomes but can be harmful if released into other parts of the body, causing UTIs, blood infections, and meningitis.
- Pseudomonas aeruginosa, a pneumonia-causing bacteria that is responsible for a large number of hospital-acquired infections
- Staphylococcus aureus, a bacteria that leads to staph infections, which are fatal in between 10% and 30% of cases once the infection enters the bloodstream and account for more deaths in the United States each year than HIV, hepatitis, and tuberculosis combined.
- Streptococcus pneumoniae, which causes pneumococcus, a form of community-acquired pneumonia.
- Escherichia coli, a bacteria found in the environment, meat products, and the human gut biome; E. coli is the most common cause of UTIs and also commonly causes “stomach flu”-like symptoms
- Enterobacter aerogenes or E cloacae, which can cause a wide range of bacterial infections including skin, urinary tract, and lung infections.
- Enterococcus faecalis, another common gut bacteria that is also used as a probiotic, but can cause infections including endocarditis, which is inflammation of the heart valves and chambers
- Enterococcus faecium, another common gut bacteria that is often the cause of infections in the prostate gland and abdominal cavity
The study found statistically significant relationships ranging from moderate to strong between fine particulate matter levels (PM2.5) and antibiotic resistance across the board. Antibiotic resistance was markedly higher in Africa, Asia, and the Middle East than in Europe and North America.
Each 1% increase in particulate matter led to an increase of between 0.5% and 1.9% in pathogens’ resistance to different antibiotics.
The study also examined a variety of other factors that may be linked to antibiotic resistance (current health expenditure per capita, rainfall, availability of clean drinking water, antibiotic use, rainfall, temperature, completion of primary education, governance, and population density. Researchers concluded that approximately 11% of rises in antibiotic resistance are attributable to air pollution levels, making it the strongest predictor of any of the factors examined.
However, it is worth noting that the strongest correlations existed between drinking water access, which led to decreased antibiotic resistance, and antibiotic use, which (as researchers expected based on existing literature) led to increased antibiotic resistance.
Although the study could not establish the reasons why this relationship exists, scientists pose several possibilities:
- Air pollution, especially particulate matter, is known to facilitate the spread of pathogens by carrying them further away from their source. In doing so, it may spread resistant bacteria to more people, causing more infections and more reproduction of the resistant strains.
- Just as it affects plants, animals, and humans, air pollution affects microorganisms, and has been shown to cause mutations in the DNA of pathogens, thus speeding up the process of evolving toward antibiotic resistance.
- Increased exposure to various air pollutants is strongly linked to increases in lung infections; this may trigger more antibiotic prescriptions, thus contributing to antibiotic resistance.
The Impact of Air Pollution on Illness and the Immune System
The study described above found a relationship between ambient air pollution levels and antibiotic resistance, but exposure mechanisms were unspecified and likely pathogens being exposed to pollutants directly and via infected humans as well as by other routes.
Breathing polluted air has additional effects on the threat of illnesses and infections. Air pollution also affects the body’s ability to fight pathogens, particularly those that affect the respiratory system. Research suggests several mechanisms that could be involved with this effect:
- pollutants damage cells, making them more susceptible to harm from pathogens when exposure occurs
- particulate matter damages immune organs such as the lymph nodes
- presence of pollutants redirects immune responses, spreading resources thin
- long-term exposure to particulate matter has been linked to an increased risk of developing an autoimmune disorder
As discussed above, the effects of air pollution on the immune system and illness outcomes are more severe for at-risk groups (children, the elderly, people with compromised immune systems, and people with existing health conditions).
Limiting Indoor Exposure to Air Pollution and Airborne Illnesses
The effects of air pollution on antimicrobial resistance, disease transmission, and immune system function is a continuously developing area of research, and combating these effects will require multifaceted, international efforts.
While there is little most individuals can do to counter global particulate matter levels, you can protect yourself from harmful pollutants and airborne pathogens with an air purifier. Most Americans spend at least 90% of their time indoors, where the air can be as much as fifty times more polluted than outdoor air due to poor circulation and ventilation, as well as the additional threat of pollutants generated indoors.
Additionally, airborne pathogens (including the virus that causes COVID-19) are more likely to spread indoors than outdoors. Using the right air filtration technology can prevent experiencing adverse health effects from air pollution as well as capturing airborne pathogens to stop them from spreading.
To effectively protect yourself against harmful pollutants, consider adding a portable room air purifier that uses both factory-tested and certified HEPA filters (which trap particulate matter, including infected respiratory droplets that spread airborne illnesses) and activated carbon filters (which remove gaseous pollutants such as ozone, sulfur dioxide, nitrogen dioxide, and volatile organic compounds).
Learn more: Camfil’s Medical-Grade City M Air Purifier
About Camfil Clean Air Solutions
For more than half a century, Camfil has been helping people breathe cleaner air. As a leading manufacturer of premium clean air solutions, we provide commercial and industrial systems for air filtration and air pollution control that improve worker and equipment productivity, minimize energy use, and benefit human health and the environment. We firmly believe that the best solutions for our customers are the best solutions for our planet, too. That’s why every step of the way – from design to delivery and across the product life cycle – we consider the impact of what we do on people and on the world around us. Through a fresh approach to problem-solving, innovative design, precise process control, and a strong customer focus we aim to conserve more, use less and find better ways – so we can all breathe easier.
The Camfil Group is headquartered in Stockholm, Sweden, and has 30 manufacturing sites, six R&D centers, local sales offices in 35+ countries, and about 5,600 employees and growing. We proudly serve and support customers in a wide variety of industries and in communities across the world. To discover how Camfil USA can help you to protect people, processes and the environment, visit us at www.camfil.us/
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