Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Catalonia, Spain.
Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
JAMA Netw Open. 2024 Sep 3;7(9):e2432245. doi: 10.1001/jamanetworkopen.2024.32245.
Ambient air pollution and antimicrobial resistance pose significant global public health challenges. It is not known whether ambient air pollution is associated with increased consumption of antimicrobials.
To assess whether a short-term association exists between ambient air pollution levels and antimicrobial consumption among the general population seeking primary care consultations for acute respiratory symptoms.
DESIGN, SETTING, AND PARTICIPANTS: This 2-stage cross-sectional ecological time series analysis study using data on daily ambient air pollution and antimicrobial consumption was conducted in the 11 largest cities in Catalonia, Spain, from June 23, 2012, to December 31, 2019, among all inhabitants aged 12 years or older. Statistical analysis was performed from November 2022 to December 2023.
Daily ambient air pollution (particulate matter of 10 μg/m3 [PM10], particulate matter of 2.5 μg/m3 [PM2.5], and nitrogen dioxide [NO2]).
The main outcome was antimicrobial consumption associated with primary care consultations for acute respiratory symptoms in the 30 days before and after the dispensing of the antimicrobial. Antimicrobial consumption was measured as defined daily doses (DDDs) per 1000 inhabitants per day.
Among 1 938 333 inhabitants (median age, 48 years [IQR, 34-65 years]; 55% female participants), there were 8 421 404 antimicrobial dispensations, with a median of 12.26 DDDs per 1000 inhabitants per day (IQR, 6.03-15.32 DDDs per 1000 inhabitants per day). The median adjusted morbidity score was 2.0 (IQR, 1.0-5.0). For the 1 924 814 antimicrobial dispensations associated with primary care consultations for acute respiratory symptoms, there was a significant correlation between increases of 10 μg/m3 in the concentration of the 3 pollutants studied and heightened antimicrobial consumption at day 0 (PM10: relative risk [RR], 1.01 [95% CI, 1.01-1.02]; PM2.5: RR, 1.03 [95% CI, 1.01-1.04]; NO2: RR, 1.04 [95% CI, 1.03-1.05]). A delayed association emerged between increases in PM2.5 concentration and antimicrobial consumption between day 7 (RR, 1.00 [95% CI, 1.00-1.01]) and day 10 (RR, 1.00 [95% CI, 1.00-1.01]) after exposure.
In this 2-stage cross-sectional study using ecological time series analysis, short-term exposure to air pollution was associated with increased antimicrobial use associated with primary care consultations for acute respiratory symptoms in the general population. This finding could contribute to informing policy decisions aimed at reducing air pollution and its associated risks, thereby promoting respiratory health and reducing antimicrobial use.
环境空气污染和抗微生物药物耐药性构成了重大的全球公共卫生挑战。目前尚不清楚环境空气污染是否与抗微生物药物的消耗增加有关。
评估大气污染水平与一般人群因急性呼吸道症状寻求初级保健咨询而导致的抗微生物药物消耗之间是否存在短期关联。
设计、地点和参与者： 本研究采用西班牙加泰罗尼亚 11 个最大城市的每日环境空气污染和抗微生物药物消耗数据，于 2012 年 6 月 23 日至 2019 年 12 月 31 日进行了两阶段的横断面生态时间序列分析，参与者为所有 12 岁或以上的居民。统计分析于 2022 年 11 月至 2023 年 12 月进行。
每日环境空气污染（10μg/m3[PM10]、2.5μg/m3[PM2.5]和二氧化氮[NO2]的颗粒物）。
主要结果是与急性呼吸道症状初级保健咨询后 30 天内抗微生物药物消耗相关的结果。抗微生物药物消耗以每 1000 名居民每天的定义日剂量（DDD）测量。
在 1938333 名居民（中位数年龄，48 岁[IQR，34-65 岁]；55%的女性参与者）中，有 8421404 次抗微生物药物配药，中位数为每 1000 名居民每天 12.26 DDD（IQR，每 1000 名居民每天 6.03-15.32 DDD）。中位数调整发病率评分 2.0（IQR，1.0-5.0）。对于与急性呼吸道症状初级保健咨询相关的 1924814 次抗微生物药物配药，研究中三种污染物浓度每增加 10μg/m3，与抗微生物药物消耗增加在第 0 天（PM10：相对风险[RR]，1.01[95%CI，1.01-1.02]；PM2.5：RR，1.03[95%CI，1.01-1.04]；NO2：RR，1.04[95%CI，1.03-1.05]）存在显著相关性。在暴露后第 7 天（RR，1.00[95%CI，1.00-1.01]）和第 10 天（RR，1.00[95%CI，1.00-1.01]），PM2.5浓度的延迟关联与抗微生物药物消耗之间出现关联。
在这项使用生态时间序列分析的两阶段横断面研究中，短期暴露于空气污染与一般人群因急性呼吸道症状而接受的抗微生物药物使用增加有关。这一发现可能有助于为旨在减少空气污染及其相关风险的政策决策提供信息，从而促进呼吸道健康和减少抗微生物药物的使用。
