College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, China.
Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
Lancet Planet Health. 2023 Aug;7(8):e649-e659. doi: 10.1016/S2542-5196(23)00135-3.
Antibiotic resistance is an increasing global issue, causing millions of deaths worldwide every year. Particulate matter (PM) has diverse elements of antibiotic resistance that increase its spread after inhalation. However, understanding of the contribution of PM 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 pollution.
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 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 in different scenarios (eg, 50% reduced antibiotic use or PM controlled to 5 μg/m) were projected until 2050.
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 and antibiotic resistance were consistent globally in most antibiotic-resistant bacteria (R=0·42-0·76, p<0·0001), and correlations have strengthened over time. Antibiotic resistance derived from PM 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/m target of concentration of PM 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.
This analysis is the first to describe the association between PM and clinical antibiotic resistance globally. Results provide new pathways for antibiotic-resistance control from an environmental perspective.
National Natural Science Foundation of China, Fundamental Research Funds for the Central Universities, Zhejiang University Global Partnership Fund, and China Postdoctoral Science Foundation.
抗生素耐药性是一个日益严重的全球问题，每年在全球导致数百万人死亡。颗粒物（PM）具有多种抗生素耐药性元素，增加了吸入后的传播。然而，人们对抗生素耐药性的颗粒物的贡献知之甚少。通过单变量和多变量分析，我们旨在首次对全球范围内因 PM 污染导致的抗生素耐药性和与过早死亡相关的抗生素耐药性负担进行全球估计。
在这项全球分析中，我们收集了 2000 年至 2018 年 116 个国家的多种潜在预测因子（即空气污染、抗生素使用、卫生服务、经济、卫生支出、人口、教育、气候、年份和地区）的数据，通过单变量和多变量分析来估计 PM 对抗生素耐药性的影响。数据来自 ResistanceMap、欧洲疾病预防控制中心监测地图集（抗生素耐药性来源）和 PLISA 美洲健康信息平台。根据不同情景（例如，减少 50%的抗生素使用或将 PM 控制在 5μg/m 以下）对未来全球范围内 PM 导致的抗生素耐药性和过早死亡趋势进行了预测，预测持续到 2050 年。
最终数据集包括超过 1150 万个测试分离株。原始抗生素耐药性数据包括九种病原体和 43 种抗生素制剂。在大多数抗生素耐药菌中，PM 与抗生素耐药性之间的相关性在全球范围内均具有统计学意义（R=0.42-0.76，p<0.0001），且相关性随着时间的推移而增强。PM 导致的抗生素耐药性导致 2018 年全球估计有 0.48（95%CI 0.34-0.60）百万人过早死亡和 18.2（13.4-23.0）百万人年生命损失，相当于因过早死亡导致的年度福利损失 3950 亿美元（2900-5000 亿美元）。如果到 2050 年达到世界卫生组织空气质量指南中设定的 PM 浓度 5μg/m 的目标，预计抗生素耐药性将降低 16.8%（95%CI 15.3-18.3），并避免 23.4%（21.2-25.6）因抗生素耐药性导致的过早死亡，相当于节省 640 亿美元（580-671 亿美元）。
这是首次描述全球范围内 PM 与临床抗生素耐药性之间的关联。研究结果为从环境角度控制抗生素耐药性提供了新途径。
国家自然科学基金、中央高校基本科研业务费专项资金、浙江大学全球伙伴关系基金和中国博士后科学基金。
