Reducing antimicrobial resistance: accelerated efforts are needed to meet the EU targets

Marking European Antibiotic Awareness Day on 18 November and the start of World Antimicrobial Resistance Awareness Week, ECDC presents new data on antimicrobial consumption and resistance

European Centre for Disease Prevention and Control (ECDC)

 

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Antimicrobial resistance (AMR) has an impact on people lives.

The situation with antimicrobial resistance is getting worse, and new bacterial strains are emerging that are resistant to several antibiotics at the same time (known as multidrug-resistant bacteria). A major antimicrobial resistance problem, especially in hospitals, is the emergence of bacteria that are resistant to last-line antimicrobials, which severely limits treatment options for infected patients. Such bacteria may eventually become resistant to all existing antimicrobials.

AMR is invisible, but the patients are not.

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Credit: ECDC

Between 2019 and 2023, antibiotic consumption in the EU increased by 1%, moving further away from the 2030 target of a 20% reduction recommended by the Council of the European Union.

Although there have been significant reductions in methicillin-resistant Staphylococcus aureus bloodstream infections during the same period, the situation in other critical areas, such as carbapenem-resistant Klebsiella pneumoniae bloodstream infections, has worsened, with an increase in incidence by almost 60% between 2019 and 2023. This represents a growing threat to patients in hospitals across the EU, particularly since very few therapeutic options remain available to treat patients infected with carbapenem-resistant K. pneumoniae. 

Reaching the EU targets by 2030 requires a united, urgent response across the EU to prevent AMR from undermining healthcare. This response is key to protecting patients and sustaining the effectiveness of antibiotics for future generations.’  says Dr Pamela Rendi-Wagner, ECDC Director. 

To highlight the serious threat presented by antimicrobial resistance (AMR), ECDC has launched a series of patient stories to give a voice to people who have experienced prolonged hospital stays, uncertain recovery and complex treatments due to AMR. The stories also talk about the impact that these infections have had on the patients’ lives and families. 

While some Member States have made great progress towards their recommended AMR targets, or even in some instances have already reached the recommended targets, the overall picture shows that more specific, intensified interventions are urgently needed across the EU. 

To turn the tide in the fight against AMR, ECDC is calling for accelerated efforts in three main areas: infection prevention and control, prudent use of antimicrobials, and the development of and access to novel antimicrobials.

Healthcare-associated infections account for 70% of the AMR-related health burden in the EU. This is why hospitals must prioritise basic, yet critical measures for infection prevention and control, such as:
•    improving hand hygiene and giving easy access to alcohol-based solutions for hand disinfection, 
•    increasing screening for the carriage of resistant bacteria to curb the growing trend in carbapenem-resistant Klebsiella pneumoniae,
•    increasing the capacity to isolate positive patients by making sure that there are enough single rooms, 
•    increasing the number of dedicated infection prevention and control staff and relevant training.

The community sector accounts for 90% of total antibiotic use in humans. Reducing the use of antibiotics requires more information and public awareness campaigns, complemented by social and behavioural interventions to prevent their unnecessary use.

ECDC continues to promote the development of and access to novel antimicrobials, and alternatives to antimicrobials, that are both effective and safe for humans. Antimicrobials of this type are essential for treating patients with infections that are resistant to last-line antibiotics such as carbapenems. 

In the absence of stronger and swifter public health action, it is unlikely that the EU will reach all its targets by 2030. The consequence will be an increased number of infections with antimicrobial-resistant bacteria that will be more difficult to treat, leading to increasing challenges for patients and larger numbers of AMR-related deaths.

ECDC is committed to supporting Member States in achieving their 2030 AMR targets and has a range of measures to help them address specific gaps and strengthen national capabilities. These include individual AMR country visits and regular Public Health Emergency Preparedness Assessments for all EU/EEA countries, with antimicrobial resistance and healthcare-associated infections as key focus areas.

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Notes to editors:

In 2023, the estimated total EU incidence of meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infections was 4.64 per 100 000 population (country range 0−15.5). This was 17.6% lower than in 2019 (baseline year) and 0.15 per 100 000 population lower than the 2030 target of 4.79 per 100 000 population. For the EU overall, a statistically significant decreasing trend was detected between 2019 (baseline year) and 2023.

The estimated total EU incidence of third-generation cephalosporin-resistant Escherichia coli bloodstream infections was 10.35 per 100 000 population (country range 0−19.56) in 2023. This was 3.6% lower than in 2019 (baseline year) and 0.68 per 100 000 population higher than the 2030 target of 9.67 per 100 000 population. For the EU overall, there was no statistically significant trend detected between 2019 (baseline year) and 2023.

The estimated total EU incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections was 3.97 per 100 000 population (country range 0.00−21.44) in 2023. This was 57.5% higher than in 2019 (baseline year) and 1.58 per 100 000 population higher than the 2030 target of 2.39 per 100 000 population. For the EU overall, a statistically significant increasing trend was detected between 2019 (baseline year) and 2023.

In summary, while the EU target for the incidence of MRSA bloodstream infections had already been reached by 2023, the EU incidence of third-generation cephalosporin-resistant E. coli bloodstream infections only showed a small decrease compared to 2019 (baseline year) and the EU incidence of carbapenem-resistant K. pneumoniae bloodstream infections showed an increase by over 50% compared to 2019 (baseline year), which counteracts the target of a 5% reduction by 2030.

In 2024, all European Union/European Economic Area (EU/EEA) countries reported data for 2023 to the European Antimicrobial Resistance Surveillance Network (EARS-Net).Antimicrobial resistance can be expressed as the estimated total incidence of bloodstream infections with antimicrobial-resistant bacteria (infections per 100 000 population).

Data from EARS-Net show that, as in previous years, AMR levels remained high in the EU/EEA in 2023.

Increases in the estimated EU incidences of bloodstream infections with resistant bacteria were observed not only for two of the above-mentioned AMR-pathogen combinations with an EU target, but also for many other bacteria and antimicrobial groups under surveillance, such as antimicrobial-resistant K. pneumoniae (other than carbapenem-resistant), vancomycin-resistant Enterococcus faecium and piperacillin-tazobactam-, ceftazidime-, and carbapenem-resistant Pseudomonas aeruginosa.

The AMR situation reported by EU/EEA countries varied widely, depending on the bacterial species, antimicrobial group and geographical region. The highest estimated incidences of antimicrobial-resistant bloodstream infections were generally reported by countries in the south or southeast of Europe.

For each bacterial species, country-specific information on the estimated incidence of antimicrobial-resistant bloodstream infections (including the recommended EU targets on AMR), the percentage of invasive isolates with AMR, data availability and the percentage of intensive care unit patients is available in country summaries. Results by age group and sex are available in the ECDC Surveillance Atlas of Infectious Diseases (https://atlas.ecdc.europa.eu/).

Estimates based on EARS-Net data from 2020 indicate that each year more than 35 000 people die in the EU/EEA as a direct consequence of antimicrobial-resistant infections.

The overall poor progress towards the EU targets on AMR and, more particularly, the continued increase in the incidence of carbapenem-resistant K. pneumoniae bloodstream infections, highlights the urgent need for intensified public health action against AMR.

The Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach (2023/C 220/01) encourages Member States to develop and implement national action plans against AMR, and highlights the need for Member States to allocate appropriate human and financial resources for the effective implementation of these plans.

The plans should include key elements, such as enhanced surveillance and strengthened infection prevention and control programmes in hospitals and other healthcare settings, integrated with antimicrobial stewardship programmes and good diagnostic practices.

In the absence of stronger, swifter public health action, it is unlikely that the EU will reach all its AMR targets by 2030. The consequence will be an increased number of infections with antibiotic-resistant bacteria that will be more difficult to treat, leading to increasing challenges for patients and AMR-related deaths.

Read the full report "Antimicrobial resistance in the EU/EEA (EARS-Net)" for 2023, available from https://www.ecdc.europa.eu/sites/default/files/documents/antimicrobial-resistance-annual-epidemiological-report-EARS-Net-2023.pdf

Read the report "Antimicrobial consumption in the EU/EEA (ESAC-Net)" available from https://www.ecdc.europa.eu/sites/default/files/documents/antimicrobial-consumption-ESAC-Net-annual-epidemiological-report-2023_0.pdf

 

Empowering people, saving the planet: A case for direct democracy

The Hebrew University of Jerusalem

A new study explores the relationship between democratic attributes and greenhouse gas emissions, using data from over 150 countries over the recent three decades. The findings reveal that Direct Popular Voting is the most effective democratic feature in reducing emissions, while Civil Society Participation also plays a significant role. The research highlights the complex interplay between democracy, economic development, and environmental outcomes, offering insights for designing climate policies that balance democratic principles and sustainability goals.

[Hebrew University of Jerusalem]– A new study by Prof. Yacov Tsur from the Department of Environmental Economics and Management at the Hebrew University of Jerusalem offers valuable insights into the relationship between democracy’s attributes and greenhouse gas emissions. Using a comprehensive dataset from over 150 countries spanning three decades (1990–2021), the research evaluates how specific attributes of democratic governance influence emissions and provides implications for effective climate policy design.

The study highlights the significant role of Direct Popular Voting, which stands out as the most effective democratic mechanism for reducing greenhouse gas emissions. By reflecting the preferences of a broad electorate, this attribute diminishes the influence of interest groups and enables the implementation of impactful environmental policies. Civil Society Participation follows as a key factor, effectively reducing overall emissions, especially in countries with higher GDP per capita. However, its impact is less pronounced when addressing emissions from specific, well-identified sources, such as CO₂.

Direct Popular Voting is a democratic system where citizens cast their votes directly for a candidate or policy, and the outcome is determined by the majority of votes nationwide or within a specified constituency. Unlike systems that rely on intermediaries, such as an electoral college or parliamentary representation, direct popular voting reflects the immediate will of the people. It is often lauded for its transparency and simplicity, ensuring that every vote carries equal weight. However, it can raise concerns about the marginalization of minority interests and the risk of majoritarianism in diverse societies.

The research also finds that while Liberal Democracy and Political Civil Liberties are essential for safeguarding freedoms and accountability, they can complicate the implementation of stringent environmental regulations. Emphasis on individual rights and freedoms often limits the adoption of coercive measures, such as emission taxes or production bans, necessitating innovative policy solutions that balance democratic principles with environmental goals. Attributes like Freedom of Expression and Judicial Constraint on the Executive demonstrate weaker but still notable impacts on emissions, particularly in wealthier nations.

A central finding of the study is the nuanced relationship between democracy and emissions, influenced by economic development. Democratic governance initially drives emissions through its positive effects on economic growth and GDP per capita. However, beyond a certain GDP threshold, democracy supports emissions reduction, with the threshold varying depending on the specific democratic indicator and type of emission.

According to Prof. Tsur, "These findings demonstrate how democratic governance influences environmental outcomes, offering new pathways for designing climate policies that respect democratic values while achieving sustainability goals." The research underscores the importance of tailoring climate policies to a country's economic and democratic context.

By advancing our understanding of the complex interplay between democracy and environmental sustainability, this study contributes to the global conversation on climate change mitigation. Future research will explore additional dimensions of this relationship, integrating insights from multiple disciplines and focusing on diverse economic and political profiles.

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Journal

Ecological Economics

DOI

10.1016/j.ecolecon.2024.108411 

Method of Research

Case study

Subject of Research

Not applicable

Article Title

The diverse impacts of democracy on greenhouse gas emissions

 

Modeling and analysis reveals technological, environmental challenges to increasing water recovery from desalination

Zero liquid discharge technologies can ease water scarcity but at increased cost and energy consumption

Northwestern University

Climate change is making water scarcer. A promising method to combat this problem is desalination technology because it can tap seawater. Though desalination has potential, it also brings risks with environmental impact, cost, and accessibility.  Zero liquid discharge (ZLD) technology aims to increase water recovery from desalination by squeezing more water out of desalination brine. ZLD can help reduce water scarcity and waste from desalination plants, but comes at increased costs and, potentially, increased environmental effects from desalination. 

In a new analysis by a team led by Northwestern Engineering’s Jennifer Dunn that uses a novel optimization model, researchers concluded that while incorporating ZLD into desalination plants is a valuable way to fight future water scarcity. The process, however, poses notable tradeoffs when it comes to energy use, disposal of water that has salt, and cost for low-income areas.

In desalination, seawater is filtered through a membrane that removes salts, leaving fresh water and a salty brine. ZLD can increase water recovery from this brine and reduce its volume, leading to more manageable desalination waste streams. While desalination facilities are abundant in countries like Israel, Australia, and Saudi Arabia where water scarcity is acute, the energy required to desalinate water at scale presents a significant environmental hurdle. 

Due to the pressure needed to push water through membranes, high energy demand is a considerable obstacle to desalination and ZLD. This demand presents a perplexing cycle — energy production often requires water, and water production from desalination now requires significant energy.    

“The big challenge is that you need a lot of energy to desalinate water and increase water production using zero liquid discharge,” Dunn said. “That energy comes at a high environmental cost, especially if fossil fuels are the primary energy source. Renewable energy is being investigated as a cleaner power source, but these options are still limited, depending on location and available infrastructure.”

Dunn is a professor of chemical and biological engineering at the McCormick School of Engineering. She reported her findings in the paper “Analysis of Energy, Water, Land and Cost Implications of Zero and Minimal Liquid Discharge Desalination Technologies,” published November 18 in the journal Nature Water. Dunn directs the Center for Engineering Sustainability and Resilience and is the associate director of the Northwestern-Argonne Institute of Science and Engineering.

In the paper, Dunn and her colleagues evaluated methods to make ZLD more efficient. They did this by using a new optimization model that aids in the design of desalination treatment trains (multiple technologies that work together), including seven different options for treatment trains. This required extensive research on each technology included in an overall process train (series of steps that result in zero liquid discharge). The model, WaterTap, is funded by the US Department of Energy and is led by the National Alliance for Water Innovation. 

“ZLD and minimal liquid discharge processes give you more water, which can be crucial in water-scarce areas, but you’re increasing the energy and costs,” Dunn said. “In each plant, decisions need to be made based on the specific location and the resources available. It’s all about trade-offs.”   

Brine disposal also poses an environmental issue. Coastal desalination plants often pump the brine back into the ocean. However, the long-term effects of that practice are not yet known. A concern is that brine has more saline than seawater, giving it the potential to disrupt marine life in sensitive areas.

Dunn emphasized that monitoring brine disposal will be essential as desalination becomes more widespread.

“There’s not enough data on the effects of high-salinity brine on marine ecosystems,” Dunn said. “In some areas, the damage may be minimal, but in others, it could be disruptive. We’re working to fill those gaps.”   

Desalination is costly, presenting problems for low-income regions that have the biggest issues with water access. Desalination plants are expensive to build, operate, and maintain, and require large amounts of energy. Some countries do provide subsidies for desalinated water; unfortunately, they can be insufficient.

“Desalination can’t be the only solution,” Dunn said. “In some areas, it’s essential, but it must be part of a broader water management strategy.”

Dunn pointed out that several countries are taking a “multi-faceted” approach to address a lack of water by combining desalination with methods such as water recycling, rainwater harvesting, and conservation measures. That mix of techniques has obvious advantages, better preparing communities for unpredictable resources and increasing demand.

"Desalination is crucial in certain regions, but it can’t be the only answer to water scarcity," Dunn said. "To make real progress, we need to look at it as one piece of a broader, more sustainable water management strategy that’s adapted to the unique needs and constraints of each area."   

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Journal

Nature Water

DOI

10.1038/s44221-024-00327-1 

Method of Research

Computational simulation/modeling

Subject of Research

Not applicable

Article Title

Analysis of energy, water, land and cost implications of zero and minimal liquid discharge desalination technologies

Article Publication Date

18-Nov-2024

 

Can podcasts create healthier habits?

University of South Australia

 

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Podcasts are highly valued for their authenticity and reliability, as well as their impactful, experience-focussed, and narrative-driven content.

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Credit: "Fitness Male" by Direct Media is marked with CC0 1.0.

Whether it’s ABC Listen’s Health Report or Mamamia’s But Are You Happy, podcasts have fast become a part of our everyday media consumption. In fact, the average person spends more than five hours a week listening to them. But could listening to podcasts lead to healthier habits?

 

In the first study of its kind, University of South Australia researchers have explored just this, finding that podcasts can significantly improve health knowledge, increase exercise levels, and boost healthy eating.

 

Reviewing results from 38 studies, researchers found that people’s engagement with health-related podcasts was generally high, suggesting that podcasts could be an effective medium for health information and behaviour change interventions.

 

Nielsen data shows that podcast popularity has increased by 16% since last year, cementing this on-demand media in the everyday lives of 9.6 million Australians.

 

UniSA researcher Beth Robins says the findings highlight the potential of podcasts promoting positive health behaviours.

 

“Health and wellbeing podcasts have the unique ability to convey a wide range of health topics to a variety of listeners, but in a very accessible way,” Robins says.

 

“Not only are podcasts typically chatty and conversational – which makes them easy to listen to and understand – but they’re also available at the touch of a button, so they’re extremely convenient, portable, and can be listened to at any time of the day.”

 

The study found that the most common motivations for listening to a health podcast was to gain information, better understand mental health issues, and to seek entertainment.

 

UniSA researcher Dr Ben Singh says the high engagement with health podcasts presents an advantage over other health interventions for sharing important public health messages.

 

“Our study is the first to review the evidence about health podcasts for the general population,” Dr Singh says.

 

“From this study, we know that podcasts are highly valued for their authenticity and reliability, as well as their impactful, experience-focussed, and narrative-driven content.

 

“They’re also valued for their ability to be consumed at the user’s pace and in a setting that suits them – whether that’s while relaxing at home or walking the dog – and this aligns with increasing consumer demand for health resources that are both informative and adaptable to individual lifestyles.

 

“While more research is warranted, podcasts are clearly a highly engaging, well-received resource that can positively impact health behaviours and outcomes. It’s certainly a watch this space.”

 

Notes to editors:

 

Researchers on the study included: UniSA’s Beth Robins, Dr Ben Singh and Prof Carol Maher, as well as University of Newcastle’s Tessa Delaney.

…………………………………………………………………………………………………………………………

Contacts for interview:  Beth Robins E: Beth.Robins@unisa.edu.au

Dr Ben Singh E: Ben.Singh@unisa.edu.au
Media contact: Annabel Mansfield M: +61 479 182 489 E: Annabel.Mansfield@unisa.edu.au

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Journal

Digital Health

DOI

10.1177/20552076241288630 

Method of Research

Systematic review

Subject of Research

Not applicable

Article Title

Podcasts as a tool for promoting health-related behaviours: A scoping review

 

Revealing the hidden costs of what we eat

Researchers find that shifting diets will ease cumulative environmental pressures for many but increase them for others

University of California - Santa Barbara

(Santa Barbara, Calif.) — Shifting our diets to be more sustainable can be a powerful way for each of us to address both climate change and global food insecurity, however making such adjustments at the large scales necessary to make a difference globally can be a delicate matter.

“Changes in food demand in one part of the world can have cascading environmental and human welfare implications for people around the world),” said Joe DeCesaro, data analyst at UC Santa Barbara’s National Center for Ecological Analysis & Synthesis (NCEAS).

Despite the seemingly daunting complexity of the global food system, to ensure a healthy population and planet, global diet shifts are required. To remove some of the uncertainty surrounding such an ambitious yet necessary endeavor, DeCesaro and an international collaboration of researchers set out to understand where and how these environmental pressures might occur within hypothetical global shifts to each of four types of diets: Indian, Mediterranean, EAT-Lancet (largely plant-based, “flexitarian”) and average government-recommended food-based dietary guidelines (FBDGs). The most beneficial of the four? The Indian diet, with an estimated 20.9% reduction in food production-based global environmental pressure. The least beneficial of the selected diets? FBDGs, with a potential 35.2% global increase in environmental pressure.

The researchers’ study is published in the journal Environmental Research Letters.

Following food flow

The global food system is one of the largest drivers of environmental change, according to the study, contributing to about a third of global greenhouse gas emissions and using more than 70% of freshwater resources, on top of degrading and disturbing land for agriculture and contributing the majority of nutrient pollution in waterways and coastal waters. For these reasons, moving toward a more sustainable diet — one that leans away from resource-intensive foods like red meat, for instance — can ease the pressure on the environment, with the added benefit of being healthier, especially when the diet also involves cutting back on refined sugars and starches and increasing nutrient-dense foods such like vegetables and legumes.

But that’s just part of the solution, according to the researchers.

“We wanted to know who would actually be feeling the change from the food production if these shifts occur,” said Ben Halpern, NCEAS director and a coauthor on the study. What has not been well understood is how environmental pressures may move, or if new ones might be generated by a large-scale shift in diet, especially given that food is often produced in one part of the world and eaten in another part of the world.

“The research was motivated originally by the question: Who’s consumption is generating the pressures of food production that are being felt by people and places around the world?” DeCesaro said. “Are poorer countries paying the environmental price of producing higher pressure foods that are being eaten by richer countries or vice versa? Our methods allow us to track changes in the environmental pressures from the producer to the consumer, and vice versa, in a standardized format across four pressures. Our work is quite novel in this space.”

Using available data on a variety of factors, including countries’ average diets, trade flow and the global environmental pressures of food production, the researchers were able to map to a high degree of precision the changes in environmental pressure that would occur with a global shift to each of four types of diets, the mostly vegetarian Indian diet, the plant-forward Mediterranean and EAT-Lancet diets, and average government-recommended dietary guidelines.

“We felt these four diet scenarios gave us a good variation of diet types from low meat to higher quantities of meat and dairy while also maintaining cultural relevance,” noted DeCesaro. “The Indian and FBDGs being directly from government recommendations, the Mediterranean being widely discussed for its health benefits, and the EAT-Lancet diet being developed by subject matter experts.” 

The researchers found that shifts to three of the four diets examined — all except the FBDGs — resulted in reductions in global cumulative pressure. The Indian diet in particular performed the best out of the sustainable popular diets largely due to the difference in red meat consumption — the Indian diet recommends no red meat while the FBDGs typically recommend more red meat than countries already consume.

Meanwhile, global reductions in pressure, according to the study, would come mostly from dietary shifts in higher-income countries. 

“Higher-income countries’ average current diets have higher consumption quantities of most food categories than the recommended quantities in our diet scenarios,” DeCesaro said. “Essentially, these countries are over-consuming, compared to the recommendations of the diet scenarios, while lower-income countries are, on average, under-consuming in these categories.” 

Additionally, should the world shift toward more sustainable, plant-forward diets, lower-income countries would see an increase to their food-production related environmental pressures, DeCesaro said, “but that is mainly due to the diet scenarios meeting more of their daily needs.” To ensure the goals of food security and equitable access to adequate nutrition for these countries, the authors call for support from wealthier countries via access to imports of efficiently produced foods, economic development where it can improve dietary health and reduce environmental pressures of food production, and through innovation and knowledge sharing of efficient and environmental food production practices.

“Sharing sustainable agricultural practices will help reduce any increases in pressures seen from diet shifts,” DeCesaro said. Continuing in this vein, the researchers are currently working to directly analyze current food trade patterns and the subsequent environmental pressures traded with it, with no diet shifts.

“A big message from our work,” summarized Halpern, “is that the decisions we make about what we eat are important for reducing our environmental footprint, but other people may pay the price for those decisions.”

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Journal

Environmental Research Letters

Article Title

The distribution of environmental pressures from global dietary shift

 

American soil losing more nutrients for crops due to heavier rainstorms, study shows

Loss of phosphorus from agricultural lands is increasing due to heavier storms, potentially threatening crop growth, according to team led by researchers at Penn State

Penn State

 

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A Penn State-led study analyzed data from 430 rivers across the U.S. and found that phosphorus loss from agricultural lands has increased over the past four decades, despite efforts to reduce it. This loss of phosphorus can potentially lead to decreased crop yields, which can possibly drive up the cost of food, the researchers explained.

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Credit: Tyler Groh/Penn State

UNIVERSITY PARK, Pa. — Phosphorus, a nutrient in soil essential for sustaining most forms of life, is increasingly disappearing from land as it is washed into waterways throughout the United States, according to a new study led by researchers at Penn State.

The study, published today (Nov. 18) in the Proceedings of the National Academy of Sciences, analyzed data from 430 rivers across the U.S. and found that phosphorus loss from agricultural lands has increased over the past four decades, despite efforts to reduce it. This loss of phosphorus can potentially lead to decreased crop yields, which could drive up the cost of food, the researchers explained.

“We’ve seen from recent weather events that water quantity, the amount of water that storms and waterways carry, can lead to dangerous flooding and mudslides,” said Li Li, professor of civil and environmental engineering at Penn State and corresponding author on the study. “What we wanted to understand is what happens to the land when these storms pull the subsurface of the soil into rivers and streams. What we found is an alarming loss of this finite element that lets soil sustain life.”

Phosphorus plays an essential role in various biological processes, like creating DNA structure and facilitating the energy transfer between cells, Li explained. But unlike nitrogen, another critical soil nutrient, phosphorus is a non-renewable resource with limited geological deposits, meaning that once it moves from land to water, it can’t get back into the land.

“This is a problem for many reasons,” Li said. “When it's lost from farmland, it can reduce crop yields, potentially leading to higher food prices. Then, when phosphorus enters our waterways, it can cause harmful algal blooms that can make water unsafe for swimming and fishing — and can even reduce oxygen levels in water and kill fish and other aquatic life. It also makes it more expensive to treat drinking water, which means higher water bills for all of us.”

The study used a sophisticated deep learning model to analyze four decades of data, from 1980 to 2019, from 430 rivers throughout the contiguous United States. It revealed that while 60% of the rivers studied showed declining levels of phosphorus, the overall amount of phosphorus flowing into rivers has increased. Agricultural areas are the biggest contributors to the problem, with phosphorus levels increasing in most rivers near agricultural areas, even as they decline in rivers near urban areas.

“This suggests that efforts to control phosphorus pollution from sources like agricultural runoff are not as effective as we thought,” Li said. “But declining levels of phosphorus, particularly in rivers flowing through urban areas, suggests that efforts to control phosphorus pollution from point sources such as wastewater treatment plants are working.”

Despite these targeted efforts, Li said the overall increased amount of phosphorus flowing into rivers is due to the increased frequency of extreme weather events that lead to heavier rainfall and higher river flows — with that increased flow comes more phosphorus.

“This means that even though we're doing a better job at limiting phosphorus pollution from urban areas, the problem is getting worse overall, due to factors largely beyond the control of just one region,” Li said. “This is a problem that is tied to climate change.”

Going forward, the study's authors said phosphorus pollution from agriculture needs better prevention and mitigation, which will be a challenge, especially as wetter storms drive increased rainfall and river flows. They said that this will likely require a combination of new technologies and changes to farming practices.

One such technology was invented at Penn State and is currently garnering support from the agricultural technology sector to address the problem at scale. Hunter Swisher, a 2016 Penn State alumnus, is the founder and chief executive officer of Phospholutions, a fertilizer formulated to increase phosphorus efficiency in the soil.

He developed the company’s technology during his undergraduate studies in plant sciences at Penn State. The company recently announced the results of a study proving that the product reduces runoff potential by 78% compared to conventional phosphorus fertilizers. Phospholutions is actively commercializing throughout the Americas, Europe and India.

“We are advocating for more innovation, more creativity and more urgency,” Li said. “The connection between water and land is essential and that balance is growing increasingly fragile.”

Other Penn State authors are Wei Zhi, former assistant research professor of civil and environmental engineering at Penn State and currently a professor in Hohai University in China; Jiangtao Liu, a doctoral student in civil and environmental engineering; Elizabeth Boyer, professor of environmental science; Chaopeng Shen, professor of water resources engineering; and Xiaofeng Liu, associate professor of civil engineering. Other authors are Hubert Baniecki of University of Warsaw in Poland and Gary Shenk of the United States Geological Survey.

This work was supported by the Barry and Shirley Isett Professorship at Penn State, the High Performance Computing Platform of Hohai University, the U.S. National Science Foundation, the U.S. Department of Energy and the Polish Ministry of Education and Science.

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Journal

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2402028121 

Method of Research

Computational simulation/modeling

Subject of Research

Not applicable

Article Title

Increasing phosphorus loss despite widespread concentration decline in US rivers

Article Publication Date

18-Nov-2024

 

Global antibiotic consumption has increased by more than 21 percent since 2016

An analysis of antibiotic sales data from 67 countries from 2016-2023 shows a decrease in consumption in high-income countries countered by an increase in middle-income countries

One Health Trust

Washington, DC / Bangalore, India — A new study highlights recent, but fluctuating, growth in global human antibiotic consumption, one of the main drivers of growing antimicrobial resistance (AMR). AMR results in infections that no longer respond to antibiotics (and other antimicrobial medicines) and often leads to longer hospital stays, higher treatment costs, and higher mortality rates. AMR is estimated to be associated with nearly five million global deaths annually.

Researchers affiliated with the One Health Trust (OHT), the Population Council, GlaxoSmithKline, the University of Zurich, the University of Brussels, Johns Hopkins University, and the Harvard T.H. Chan School of Public Health analyzed pharmaceutical sales data from 67 countries from 2016-2023 for the effects of the COVID-19 pandemic and economic growth on human antibiotic consumption. The study provides a breakdown of global antibiotic sales in reported countries by national income level, antibiotic class, and antibiotic grouping according to the World Health Organization’s (WHO) AWaRe classification system for antibiotic stewardship and projects consumption through 2030. The study is published in the Proceedings of the National Academy of Sciences (PNAS).

The study found:

• Overall antibiotic sales increased in reporting countries from 2016-2023. Antibiotic sales in 67 reporting countries increased by 16.3 percent from 2016 to 2023, from 29.5 billion defined daily doses (DDDs) to 34.3 billion DDDs. This result reflected a 10.2 percent increase in the overall consumption rate in these countries from 13.7 to 15.2 DDDs per 1,000 inhabitants per day.
• Before the COVID-19 pandemic, antibiotic consumption rates in high-income countries were decreasing, and consumption rates in middle-income countries were increasing. From 2016-2019, antibiotic consumption rates (DDDs per 1,000 inhabitants per day) increased in middle-income countries (9.8 percent) while decreasing in high-income countries (-5.8 percent).
• The COVID-19 pandemic was significantly correlated with an overall reduction in antibiotic sales, most pronounced in high-income countries. An interrupted time series analysis showed that the onset of the COVID-19 pandemic in 2020 resulted in significantly decreased antibiotic consumption rates across income groups. The decrease was most pronounced in high-income countries, with the consumption rate falling 17.8 percent from 2019 to 2020. In 2021, lower-middle-income countries led high-income countries in antibiotic consumption rates as high-income countries experienced more sustained reductions.
• Middle-income countries experienced increased Watch antibiotic sales relative to Access antibiotic sales throughout the study period. High-income countries consumed consistently higher and overall increasing levels of Access antibiotics compared to Watch antibiotics as defined by the WHO’s AWaRe system. Middle-income countries consumed consistently higher and overall increasing Watch antibiotics relative to Access antibiotics.
• Middle-income countries experienced the largest increases in antibiotic consumption rates from 2016-2023. All five of the regions with the largest increases in their antibiotic consumption rate over the study period were made up of middle-income countries.
• By 2030, global consumption is expected to increase by 52.3 percent to 75.1 billion DDDs. Global projections based on the data from 67 countries show that by 2030, antibiotic consumption is expected to increase from 49.3 billion DDDs by 52.3 percent (uncertainty range [UR]: 22.1 to 82.6 percent) to a total of 75.1 (UR: 60.2 to 90.1) billion DDDs.

This study sheds light on recent trends in consumption across country income levels that can be used to help promote the careful use of antibiotics and other public health interventions that may reduce antibiotic consumption, such as improved infection prevention and control measures and increased childhood vaccination coverage. The study also has implications for future pandemic preparedness.

According to Dr. Eili Klein, lead author of the study and Senior Fellow at OHT, “The COVID-19 pandemic temporarily disrupted antibiotic use, but global consumption has rebounded quickly and continues to rise at an alarming rate. To address this escalating crisis, we must prioritize reducing inappropriate antibiotic use in high-income nations while making substantial investments in infrastructure in low- and middle-income countries to curb disease transmission effectively.”

“Global trends in antibiotic consumption during 2016–2023 and future projections through 2030” is available in PNAS (DOI: 10.1073/pnas.2411919121).

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About the One Health Trust

The One Health Trust (OHT), which was founded as the Center for Disease Dynamics, Economics & Policy (CDDEP) in 2010, uses research and stakeholder engagement to improve the health and well-being of our planet and its inhabitants. For more than a decade, OHT researchers have conducted vitally important work on major global health challenges, including Covid-19, antimicrobial resistance, hospital infections, tuberculosis, malaria, pandemic preparedness and response, vaccines, medical oxygen shortages, and noncommunicable diseases. OHT’s mandate includes issues related to climate change, biodiversity protection, and the effect of changing human diets on the planet.  

At OHT, we believe that answers to the world’s most critical questions lie between disciplines. Accordingly, our researchers employ a range of expertise—from economics, epidemiology, disease modeling, and risk analysis to clinical and veterinary medicine, geographic information systems, and statistics—to conduct actionable, policy-oriented research. 

OHT has offices in Washington, D.C. and Bangalore, India, with researchers based in North America, Africa, and Asia. Our projects lead to policy recommendations and scientific studies published in leading journals. We are experienced in addressing country-specific and regional issues as well as global challenges. Our research is renowned for innovative approaches to design and analysis, and we communicate our work to diverse stakeholders. 

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Journal

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2411919121 

Article Title

Global trends in antibiotic consumption during 2016–2023 and future projections through 2030

Article Publication Date

18-Nov-2024

Study to explore antibiotics role in childhood asthma

Vanderbilt University Medical Center

 

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Christian Rosas-Salazar, MD, MPH, assistant professor of Pediatrics, Allergy, Immunology, Pulmonary Medicine at Monroe Carell Jr. Children's Hospital at Vanderbilt.

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Credit: Vanderbilt University Medical Center

The use of antibiotics in the first year of life has been found to be a risk factor for the development of childhood asthma.

What is not known is how to protect children from the long-term effects of infant antibiotic use. Researchers at Monroe Carell Jr. Children’s Hospital at Vanderbilt are seeking to determine the age when infants are most susceptible to the risk of developing childhood asthma once exposed to antibiotics and the pathways through which infant antibiotic use can increase the risk childhood asthma onset.

“There are currently no strategies to prevent asthma, the most common chronic lung disease in children,” said Christian Rosas-Salazar, MD, MPH, assistant professor of Pediatrics, Allergy, Immunology, Pulmonary Medicine at Monroe Carell. “Understanding the mechanisms that lead to asthma in children who receive antibiotics in early life can help us develop interventions to prevent this condition.

“By examining how antibiotics can disrupt an infant’s microbiome and identifying a critical window of opportunity to intervene, the ultimate goal of this project is to inform the design of microbiome-based therapeutics, such as probiotics and/or bacterial products that can help deliver antibiotics safely during early life and reduce the burden of childhood asthma.”

Rosas-Salazar received $4.1 million from the National Heart, Lung and Blood Institute to conduct a five-year study, “Effect of infant antibiotics on the development of early-life airway and gut microbiome and risk of childhood asthma,” where his team will use available data and biospecimens collected from several birth cohorts from across the country that are part of the Environmental Influences on Child Health Outcomes (ECHO) Program of the National Institutes of Health.

Results from previous studies indicate that the association of antibiotic exposure early in childhood and the risk of developing asthma is likely due to changes in the human microbiome, but the techniques utilized couldn’t accurately identify relevant bacterial species or functions. Rosas-Salazar said that is critical in designing interventions to prevent long-term detrimental effects of infant antibiotic use.

“Our objective is to address a critical and unmet need,” said Rosas-Salazar. “The findings could be used to develop microbiome-based interventions to prevent childhood asthma in children needing antibiotics in early life,” he said.