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• W3156827092 abstract "Air pollution and antimicrobial resistance are two of the most important public health problems facing the world today. Although the harmful effects of air pollution have been known at least since the beginning of the 20th century, governments and economic leaders around the world remain reluctant to comply with international agreements drawn up to reduce the emission of air pollutants and greenhouse gases. A statistic that arouses particular concern is the fact that in 2019, according to the 2020 State of Global Air report, air pollution moved up from the fifth to the fourth leading risk factor for mortality worldwide, with 6.67 million attributable deaths. According to data from the European Public Health Alliance, in 2018 every inhabitant of a European city suffered an average annual welfare loss of over €1250 owing to direct and indirect health losses associated with poor air quality [[1]de Bruyn S. de Vries J. Health costs of air pollution in European cities and the linkage with transport.2020https://cleanair4health.eu/wp-content/uploads/sites/2/2020/10/final-health-costs-of-air-pollution-in-european-cities-and-the-linkage-with-transport-c.pdfDate accessed: March 13, 2021Google Scholar]. Several studies have identified particulate matter as the main indicator of the health effects of pollution [[2]Brunekreef B. Holgate S.T. Air pollution and health.Lancet. 2002; 360: 1233-1242https://doi.org/10.1016/S0140-6736(02)11274-8Abstract Full Text Full Text PDF PubMed Scopus (2900) Google Scholar]. In addition to particulate matter, air pollution includes chemical particles such as tropospheric ozone (O3), carbon monoxide, nitrogen oxides, and sulphur oxides (SO2 and SO3). It is known that chronic exposure to other particles also has detrimental health effects and that, in the case of SO2 and O3, this damage may occur even at levels below the limits set by guidelines. To date, outdoor air pollution has been implicated in the development of numerous serious diseases such as lung cancer, stroke, cardiac ischaemic disease, heart failure, and dementia. The effects of air pollutants on the respiratory system are well known and include the development and exacerbation of chronic obstructive pulmonary disease, asthma, and lower respiratory tract infections including pneumonia [[3]Faustini A. Stafoggia M. Colais P. Berti G. Bisanti L. Cadum E. et al.Air pollution and multiple acute respiratory outcomes.Eur Respir J. 2013; 42: 304-313https://doi.org/10.1183/09031936.00128712Crossref PubMed Scopus (97) Google Scholar]; the result is a significant increase in primary care consultations and hospital admissions due to acute respiratory syndromes. Some initial research has suggested that air pollution may even have been a contributor to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and mortality related to coronavirus disease 2019 (COVID-19) [[4]Wu X. Nethery R.C. Sabath M.B. Braun D. Dominici F. Air pollution and COVID-19 mortality in the United States: strengths and limitations of an ecological regression analysis.Sci Adv. 2020; 6eabd4049https://doi.org/10.1126/SCIADV.ABD4049Crossref PubMed Scopus (377) Google Scholar]. Another matter for concern is the fact that the effects of air pollution appear to be influenced by global warming and climate change; rising greenhouse gas levels are pushing up temperatures and thus increasing the impact of air pollution on health, and are changing the seasonality and distribution of many infectious diseases worldwide. Global antimicrobial resistance has accelerated at an alarming pace in recent years. Although its real impact remains unknown, it has been estimated that around 700 000 deaths may occur each year due to antimicrobial-resistant infections. Potential drivers of antimicrobial resistance include poverty, poor sanitation, and poor infection control in hospitals. However, antibiotic overuse continues to be the key driver of antimicrobial resistance and increases the risk of Clostridioides difficile infection and other antibiotic-related adverse events. In 2019, the average total consumption of antibiotics—including communitarian and hospital-related consumption—in the European Union was 19.4 defined daily doses per 1000 inhabitants [[5]Antimicrobial consumption—annual epidemiological report for 2019.https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-consumption-europe-2019Date accessed: December 9, 2020Google Scholar]. Specifically in the primary healthcare setting, acute respiratory tract infections are the most common reason for antimicrobial prescription, but in many cases the prescription is inappropriate [[6]Harris A.M. Hicks L.A. Qaseem A. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention.Ann Intern Med. 2016; 164: 425-434https://doi.org/10.7326/M15-1840Crossref PubMed Scopus (224) Google Scholar]. Although antimicrobial consumption has slowed in the European Union over the last decade, the differences between rich and poor countries remain high, and the need for intersectional socioeconomic and health strategies for public health problems is greater than ever. The causes of increased antimicrobial resistance also include the use and abuse of antimicrobials in animal health and the resulting spread of antimicrobial resistance genes to humans. Research driven by the One Health concept, which reflects this idea of the interdependence of animal, human and environmental health, has identified several different mechanisms of dissemination of antimicrobial resistance genes through the environment, including farming soil and salty and non-salty waters. The presence of resistance genes has also been detected in airborne microorganisms, especially in the vicinity of hospitals, farms and waste treatment plants [[7]Berendonk T.U. Manaia C.M. Merlin C. Fatta-Kassinos D. Cytryn E. Walsh F. et al.Tackling antibiotic resistance: the environmental framework.Nat Rev Microbiol. 2015; 13: 310-317https://doi.org/10.1038/nrmicro3439Crossref PubMed Scopus (1101) Google Scholar]. In 2017, Echevarria-Palencia et al. [[8]Echeverria-Palencia C.M. Thulsiraj V. Tran N. Ericksen C.A. Melendez I. Sanchez M.G. et al.Disparate antibiotic resistance gene quantities revealed across 4 major cities in California: a survey in drinking water, air, and soil at 24 public parks.ACS Omega. 2017; 2: 2255-2263https://doi.org/10.1021/acsomega.7b00118Crossref PubMed Scopus (26) Google Scholar] identified β-lactam and sulphonamide resistance genes suspended in the air in areas near city parks in California. In addition, Hu et al. [[9]Hu J. Zhao F. Zhang X.X. Li K. Li C. Ye L. et al.Metagenomic profiling of ARGs in airborne particulate matters during a severe smog event.Sci Total Environ. 2018; 615: 1332-1340https://doi.org/10.1016/j.scitotenv.2017.09.222Crossref PubMed Scopus (59) Google Scholar] reported that the concentration of these antimicrobial resistance genes rose dramatically from 4.90 ppm to 38.07 ppm during a severe smog event. Furthermore, a recent study performed in 19 cities all over the world [[10]Li J. Cao J. Zhu Y.G. Chen Q.-L. Shen F. Wu Y. et al.Global survey of antibiotic resistance genes in air.Environ Sci Technol. 2018; 52: 10975-10984https://doi.org/10.1021/acs.est.8b02204Crossref PubMed Scopus (145) Google Scholar] recorded up to 30 subtypes of antimicrobial resistance genes in air, the most frequent among them being the blaTEM gene which confers resistance to β-lactams, the most widely used antimicrobials, followed by the qepA gene, which encodes resistance to quinolones. The study also found that between 2004 and 2014 the presence of the blaTEM gene in the city of Xi'an had increased by 178% and that of the qepA gene by 26%. To date, the potential impact of air pollution on antimicrobial consumption in the general population has been overlooked. We would like to draw attention to the possible role of air pollution as a missing link between the spread of environmental antimicrobial resistance and the antimicrobial resistance observed in humans (Fig. 1). A thorough test of this hypothesis might shed new light on the process of the spread of antimicrobial resistance, and the results may provide compelling evidence for the design of more ambitious policies on antimicrobial resistance and air pollution worldwide. International big data projects with time series analysis are needed in order to evaluate the potential relationship between air pollution levels and antimicrobial consumption in the population, and also to determine the potential association between these levels of contamination and the concentration of certain antimicrobial resistance genes. All authors contributed to the idea of the commentary and to the writing of the manuscript. All authors approved the final version for publication. The authors declare that they have no conflicts of interest. This work has been funded by Instituto de Salud Carlos III through the project PI20/P01110 (co-funded by the European Regional Development Fund ( ERDF ), a way to build Europe). We thank CERCA Program/Generalitat de Catalunya for institutional support." @default.
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• W3156827092 title "One air, one health: air pollution in the era of antimicrobial resistance" @default.
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