Post Date
Mar 4 2024

Polluted Breaths, Resistant Threats: How Airborne Pollutants Fuel Antimicrobial Resistance

In the hustle and bustle of Pakistan's healthcare landscape, a silent war is raging, and it's not against a visible foe but rather microscopic troublemakers – antibiotic-resistant microbes.

Antibiotic resistance poses a growing threat to health globally. According to a report by Fleming on Antimicrobial Consumption by 700,000 individuals each year lose their lives to resistant infections. In Pakistan, this issue is exacerbated by a lack of antimicrobial stewardship in hospitals, indiscriminate antibiotic prescriptions, and a surge in respiratory diseases due to polluted air.

Healthcare providers, lacking the much-needed antimicrobial stewardship, are caught in a loop of overreliance on intravenous and oral antimicrobials. It's a revelation that makes you wonder – are we unintentionally brewing a storm of resistance right under our noses?

There's a surprising twist in the narrative of antimicrobial resistance. The air we breathe carries pollutants and potentially acts as a highway for antibiotic-resistant genes. A study by Lancet, a reputed medical journal, reveals a compelling connection between PM 2.5 air pollution and antibiotic resistance. PM 2.5 refers to particulate matter with a diameter of 2.5 micrometers or smaller. As these particles carry bacterial genomic material, inhaling them contributes to incorporating resistant genes into opportunistic pathogens, exacerbating antibiotic resistance.

Analyzing global data from 116 countries between 2000 and 2018, the study estimated that a 10% rise in annual PM 2.5 led to a 1.1% increase in aggregate antibiotic resistance, resulting in approximately 43,654 premature deaths. Regional variations highlighted potential significant increases in antibiotic resistance in Africa and Asia. Notably, for Pakistan, a 10% PM 2.5 elevation was predicted to increase antibiotic resistance by 2.6%.  

To tackle this, Dr. Shaper Mirza has been at the forefront of addressing antibiotic resistance in Pakistan. She is actively engaged in projects addressing different facets of antibiotic resistance and stewardship.  She participated in development of the first National Action Plan for Antimicrobial Resistance in Pakistan. The initiative involves identifying rates of antimicrobial resistance from a One-Health perspective in Pakistan.  This was the first effort of its kind which furnished sufficient data suggesting resistance across all sectors which include human health, animal health and agriculture. The investigation and its outcome led to the development of National Action Plan for AMR in Pakistan.  The National Action Plan was implemented in Pakistan in 2017 and currently there are 43 sentinel sites collecting and reporting data on antimicrobial resistance strains.  The Situation analysis for National Action Plan was done in collaboration with  Global Alliance for Antimicrobial Resistance Partnerships (GARP). The GARP consortium, comprising seven countries, collaborates to exchange knowledge, build capacity, and develop antimicrobial stewardship guidelines.

To improve on stewardship practices, Dr Mirza in collaboration with Pakistan Kidney and Liver Institute (PKLI) developed two courses on adult and pediatric antimicrobial stewardship.  Both courses were very well attended both by physicians and basic science researchers working in the field of antimicrobial resistance.

Tips from the experts:
As Pakistan grapples with the dual challenges of smog and antibiotic resistance, practical steps can make a difference. When the air is thick with smog, consider preventive measures like wearing masks, frequent nasal cleaning to minimize pollutant exposure and emphasizing a high-protein diet to bolster immune systems. 
While smog-induced respiratory symptoms might initially prompt concern, antibiotics are specifically designed to combat bacterial infections, not viral foes. Viruses, often the culprits behind seasonal respiratory ailments, don't respond to antibiotics. Therefore, before rushing to antibiotics, look for telltale signs of a bacterial infection – persistent high fever, green or discolored mucus, and specific radiological findings in chest X-rays. If symptoms persist, consult a healthcare professional who can guide you on the most effective and responsible course of action. By adopting these practices and following World Health Organization’s (WHO) guidelines for antibiotic usage, we protect ourselves from the smog's impact and contribute to the collective effort to preserve the effectiveness of antibiotics for when they're truly needed.

After all, a breath of fresh air should be just that – fresh and invigorating!