Rise in Air Pollution Fuels Antibiotic Resistance, Study Suggests

Yves here. This post gives a useful summary of a new study published in a Lancet branded publication. on the correlation between increases in air pollution, as in particulate matter, and increases in antibiotic resistance. The piece below points out that the study found a correlation and did not speculate about possible causation, although it cites some experts who have.

Even though it would be better to have country or even international efforts to reduce particulate pollution (serious ones, not the hand-waving or excuse for unproductive handouts sort), it is disappoint to see the article not mention how to protect yourself, particularly in acute pollution episodes.

And of course the short-term remedy is masks. From Feel tired with the pollution: Get a mask! at the Air Quality Index China website:

The most common and affordable mask are known that the 3M N95 masks (picture above is for the 3M 9501 model). Despite being very affordable (5 to 6 RMB a piece), the 3M N95 are always among the top performing masks for Particulate Matter (i.e. PM2.5 Air Pollution). One of the great advantage for the 9501 model is to be foldable, so that you can always take one with you without it taking much space. And if you forgot to take One, you can also get this mask from any convenience store in China (like 7-Eleven).

The “N95” label stands for the mask ability to filter out at least 95% of airborne particles larger than 0.3 microns (for reference, PM2.5 particles are 2.5 microns). From all the test result, N95 is good enough for filtering most of the PM2.5 particles, but sensitive persons can consider using N99 version of those masks (N99 stands for filtering more the 99% of airborne particles). Note that a similar mask, with model number 9001 is also commonly available and corresponds to N90 filtration standard.

The article above features reviews of other masks.

Needless to say, with more and more fires (now Maui!) masking up is going to be a a regular ritual, at least for the health-minded.

By Grace van Deelen. Originally published at The New Lede

Air pollution could be helping drive a rise in drug-resistant infections, which pose a dangerous threat to global public health, according to a new study.

The paper, published Monday in Lancet Planetary Health, concludes that particulate air pollution (PM2.5), which comes from burning fossil fuels for energy, industrial processes, and transportation, may be one of the largest contributors to the spread of antibiotic resistance worldwide. The link between the two phenomena has strengthened over time, according to the research.

“The benefits of controlling air pollution could be two-fold: not only will it reduce the harmful effects of poor air quality, it could also play a major role in combating the rise and spread of antibiotic-resistant bacteria,” said Hong Chen, the paper’s lead author and a professor of environmental science at Zhejiang University in China, in a statement.

The vast majority of the world’s population lives in areas where air pollution exceeds health standards set by the World Health Organization (WHO), meaning that they breath air containing high levels of pollutants, including PM2.5. Breathing polluted air raises the risk of premature death from heart disease, lung disease, stroke, and cancer affecting the lungs or airways. The Biden Administration has proposed multiple new policies to try to limit PM2.5, including tighter standards for soot pollution, new vehicle emissions standards, and improved reporting of air pollutants.

Excess Deaths 

Antibiotic resistance is a growing problem worldwide. When antibiotic resistant bacteria spread, they can cause infections that do not respond to treatment. According to the WHO, antibiotic resistance has made certain infections, such as pneumonia, tuberculosis, gonorrhea, and salmonella more difficult to treat, leading to longer hospital stays, higher medical costs, and a higher likelihood of death.

In the US alone, about 2.8 million antibiotic-resistant infections occur each year, and those infections cause more than 35,000 annual deaths, according to the Centers for Disease Control (CDC).

Misusing or overusing antibiotics is one cause of the problem, since overusing antibiotics causes infectious bacteria to develop a tolerance to the drugs. But the spread of antibiotic-resistant bacteria through humans, animals, and the environment also exacerbates the problem, and air pollution from PM2.5 may be one pathway that facilitates the spread, the new paper suggests.

The researchers used data showing antibiotic resistance in human blood and spinal fluid, along with air pollution data, from 116 countries across nearly two decades. They found that a 1% increase in air pollution was associated with increases in antibiotic resistance of up to 1.9%, depending on the exact type of bacteria.

Antibiotic resistance spread as a result of air pollution caused 480,000 premature deaths in 2018, the authors estimate. If no action to reduce air pollution is taken, more human lives will be put at risk, they write.

A Connection to Cattle

The authors of the new paper did not indicate a reason for the link between air pollution and antibiotic resistance. However, PM2.5 in the air can carry antibiotic-resistant bacteria, said Philip Smith, a professor of environmental toxicology at Texas Tech University. When those particles are inhaled by humans or animals, antibiotic-resistant infections may spread. However, said Smith, more research is needed to determine whether inhaling antibiotic-resistant bacteria from the air directly causes antibiotic-resistant infections.

Previous research by Smith and others has indicated that antibiotic drugs and bacteria carrying antibiotic-resistant genetic material are dispersed via air pollution from cattle feedlots in Texas. The animal agriculture industry is another main driver of antibiotic resistance — farmers often treat livestock with antibiotics preventatively, to avoid infections and to induce growth. The widespread use of antibiotics among livestock accelerates antibiotic resistance in on-farm bacteria, which can then spread throughout the broader environment.

“It’s really important that people begin to acknowledge that this is a really viable pathway for transmission of antibiotic resistance in the environment,” said Smith.

Global efforts to reduce air pollution could avoid almost a quarter of premature deaths due to antibiotic resistance, the authors estimate.

“Controlling air pollution … might lead to substantial health and economic benefits by reducing antibiotic resistance,” the authors wrote.

Print Friendly, PDF & Email


  1. Joe Well

    Anecdata Re: masks and air quality

    With the spread of volcanic ash in the Valley of Mexico, many people started wearing masks again, and some still are. Also, sunglasses to keep it out of your eyes. The government recommended the use of masks and glasses.

  2. Samuel Conner

    > since overusing antibiotics causes infectious bacteria to develop a tolerance to the drugs

    I think this wording is subtly wrong, as it implies that “avoiding overuse” would prevent development of resistance. Overuse hastens the emergence of resistance, but from what I have read, resistance to agents that have specific targets is essentially inevitable, since the agents select for mutant strains which are less susceptible to the agent mechanism of action. And resistance genes are common and can be horizontally transferred between different bacterial species (I’ve read that environmental stress on microbial communities promotes horizontal gene transfer; perhaps pollution is a contribution to that).

    I hope that in future we do have better “stewardship” of antibiotic efficacy. Perhaps we’ll eventually find ourselves in a situation in which first line therapies have to be combination therapies of agents with different targets, in the hope that simultaneous attack on independent targets slows emergence of resistance.

    1. Raymond Sim

      If antibiotic resistance comes with sufficient competitive disadvantages in environments not laden with antibiotics, then one could reasonably hope that use restrictions would confine resistant strains to places like hospitals, where they can be kept in check via proper hygiene, over the dead bodies of the infectious disease control people.

  3. heresy101

    “Controlling air pollution … might lead to substantial health and economic benefits by reducing antibiotic resistance,” the authors wrote.

    A real world study of the effects of adopting EVs in reducing air pollution and improving the health of different economic groups in California:

    “At the zip code level, for every additional 20 ZEVs per 1,000 people, there was a 3.2% drop in the rate of asthma-related emergency visits and a small suggestive reduction in NO2 levels. On average across zip codes in the state, ZEVs increased from 1.4 to 14.6 per 1,000 people between 2013 and 2019. ZEV adoption was significantly lower in zip codes with lower levels of educational attainment. For example, a zip code with 17% of the population having a bachelor’s degree had, on average, an annual increase of 0.70 ZEVs per 1,000 people compared to an annual increase of 3.6 ZEVs per 1,000 people for a zip code with 47% of the population having a bachelor’s degree.

    Past research has shown that underserved communities, such as lower-income neighborhoods, tend to face worse pollution and associated respiratory problems than more affluent areas. If ZEVs replace gas-powered cars in those neighborhoods, they could stand to benefit substantially.”


  4. ArvidMartensen

    100 years ago the leading cause of death was bacterial infections, from mundane things such as a scratch while gardening. The doctors and the nurses of the time took bacterial infections very seriously, having seen so many deaths, and in sometimes young and fit patients.
    Today’s doctors grew up in the era where bacterial infections were easily treated using antibiotics. And so many don’t treat bacterial infections as seriously as they should. In our family in the past year it took 4 visits to doctors and a meltdown for an older family member to get oral antibiotics to treat a relentlessly spreading bacterial infection. Sometimes topical creams just don’t do the job.

    That said, one of the facts that seems to be hidden from the public is that more than 50% of antibiotic use is in food animals, including pigs, bovines and poultry. And this has been going on since at least the 1960s. My personal experience is of my grandfather adding jam tins full of antibiotics to the bulk animal feed he was producing for the farm in the 1960s.
    And he was not alone. https://www.abc.net.au/science/slab/antibiotics/agriculture.htm
    What was not to like? Fatter and healthier animals and birds were the result. Great for the bottom line. And antibiotics were ‘harmless’.

Comments are closed.