Towards One Health action for addressing antimicrobial resistance in the age of polycrisis
Naghavi, M. et al. Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. Lancet 404, 1199–1226 (2024).
Google Scholar
Berendonk, T. U. et al. Tackling antibiotic resistance: the environmental framework. Nat. Rev. Microbiol. 13, 310–317 (2015).
Google Scholar
Djordjevic, S. P. et al. Genomic surveillance for antimicrobial resistance—a One Health perspective. Nat. Rev. Genet. 25, 142–157 (2024).
Google Scholar
Hernando-Amado, S., Coque, T. M., Baquero, F. & Martínez, J. L. Defining and combating antibiotic resistance from One Health and Global Health perspectives. Nat. Microbiol. 4, 1432–1442 (2019).
Google Scholar
Pruden, A., Vikesland, P. J., Davis, B. C. & de Roda Husman, A. M. Seizing the moment: now is the time for integrated global surveillance of antimicrobial resistance in wastewater environments. Curr. Opin. Microbiol. 64, 91–99 (2021).
Google Scholar
Winkler, A. S. et al. The Lancet One Health Commission: harnessing our interconnectedness for equitable, sustainable, and healthy socioecological systems. Lancet 406, 501–570 (2025).
Google Scholar
Li, L. et al. Assessing antimicrobial resistance connectivity across One Health sectors. Nat. Water (2025).
Spagnolo, F., Trujillo, M. & Dennehy, J. J. Why do antibiotics exist? mBio (2021).
Pruden, A., Pei, R., Storteboom, H. & Carlson, K. H. Antibiotic resistance genes as emerging contaminants: studies in northern Colorado. Environ. Sci. Technol. 40, 7445–7450 (2006).
Google Scholar
Cocker, D. et al. Healthcare as a driver, reservoir and amplifier of antimicrobial resistance: opportunities for interventions. Nat. Rev. Microbiol. 22, 636–649 (2024).
Google Scholar
Tipper, H. J., Stanton, I. C., Payne, R. A., Read, D. S. & Singer, A. C. Do storm overflows influence AMR in the environment and is this relevant to human health? A UK perspective on a global issue. Water Res. 260, 121952 (2024).
Google Scholar
Progress on Wastewater Treatment – Global Status and Acceleration Needs for SDG Indicator 6.3.1 (UN-Habitat, WHO, 2021).
Ashbolt, N., Pruden, A., Miller, J., Riquelme, M. V. & Maile-Moskowitz, A. Antimicrobial resistance: fecal sanitation strategies for combatting a global public health threat. In Global Water Pathogen Project Part 3 (eds Pruden, A. et al.) (Michigan State Univ., UNESCO, 2018); https://www.waterpathogens.org/
Manaia, C. M. Framework for establishing regulatory guidelines to control antibiotic resistance in treated effluents. Crit. Rev. Environ. Sci. Technol. 53, 754–779 (2023).
Google Scholar
Cacace, D. et al. Antibiotic resistance genes in treated wastewater and in the receiving water bodies: a pan-European survey of urban settings. Water Res. 162, 320–330 (2019).
Google Scholar
Keenum, I. et al. To what extent do water reuse treatments reduce antibiotic resistance indicators? A comparison of two full-scale systems. Water Res. 254, 121425 (2024).
Google Scholar
Samreen, Ahmad, I., Malak, H. A. & Abulreesh, H. H. Environmental antimicrobial resistance and its drivers: a potential threat to public health. J. Glob. Antimicrob. Resist. 27, 101–111 (2021).
Google Scholar
Frenk, S., Hadar, Y. & Minz, D. Resilience of soil bacterial community to irrigation with water of different qualities under Mediterranean climate. Environ. Microbiol. 16, 559–569 (2014).
Google Scholar
Kurkjian, H. M., Akbari, M. J. & Momeni, B. The impact of interactions on invasion and colonization resistance in microbial communities. PLoS Comput. Biol. 17, e1008643 (2021).
Google Scholar
Bagra, K. et al. Environmental stress increases the invasion success of antimicrobial resistant bacteria in river microbial communities. Sci. Total Environ. 904, 166661 (2023).
Google Scholar
Larsson, D. G. J. & Flach, C.-F. Antibiotic resistance in the environment. Nat. Rev. Microbiol. 20, 257–269 (2021).
Google Scholar
Akhter, S., Bhat, M. A., Ahmed, S. & Siddiqui, W. A. Antibiotic residue contamination in the aquatic environment, sources and associated potential health risks. Environ. Geochem. Health 46, 387 (2024).
Google Scholar
Wilkinson, J. L. et al. Pharmaceutical pollution of the world’s rivers. Proc. Natl Acad. Sci. USA 119, e2113947119 (2022).
Google Scholar
He, Z. et al. Understanding stimulation of conjugal gene transfer by nonantibiotic compounds: how far are we?. Environ. Sci. Technol. 58, 9017–9030 (2024).
Google Scholar
Frost, L. S., Leplae, R., Summers, A. O. & Toussaint, A. Mobile genetic elements: the agents of open source evolution. Nat. Rev. Microbiol. 3, 722–732 (2005).
Google Scholar
Khedkar, S. et al. Landscape of mobile genetic elements and their antibiotic resistance cargo in prokaryotic genomes. Nucleic Acids Res. 50, 3155–3168 (2022).
Google Scholar
Mantilla-Calderon, D. et al. Water disinfection byproducts increase natural transformation rates of environmental DNA in Acinetobacter baylyi ADP1. Environ. Sci. Technol. 53, 6520–6528 (2019).
Google Scholar
Murray, L. M. et al. Co-selection for antibiotic resistance by environmental contaminants. npj Antimicrob. Resist. 2, 9 (2024).
Google Scholar
Qiu, D. et al. Response of microbial antibiotic resistance to pesticides: an emerging health threat. Sci. Total Environ. 850, 158057 (2022).
Google Scholar
Hayes, A. et al. Predicting selection for antimicrobial resistance in UK wastewater and aquatic environments: ciprofloxacin poses a significant risk. Environ. Int. 169, 107488 (2022).
Google Scholar
Niegowska, M., Sanseverino, I., Navarro, A. & Lettieri, T. Knowledge gaps in the assessment of antimicrobial resistance in surface waters. FEMS Microbiol. Ecol. 97, fiab140 (2021).
Google Scholar
Liu, C., Shan, X., Zhang, Y., Song, L. & Chen, H. Microcosm experiments revealed resistome coalescence of sewage treatment plant effluents in river environment. Environ. Pollut. 338, 122661 (2023).
Google Scholar
Banerji, A., Jahne, M., Herrmann, M., Brinkman, N. & Keely, S. Bringing community ecology to bear on the issue of antimicrobial resistance. Front. Microbiol. 10, 2626 (2019).
Google Scholar
Custer, G. F., Bresciani, L. & Dini-Andreote, F. Ecological and evolutionary implications of microbial dispersal. Front. Microbiol. 13, 855859 (2022).
Google Scholar
Bottery, M. J., Pitchford, J. W. & Friman, V.-P. Ecology and evolution of antimicrobial resistance in bacterial communities. ISME J. 15, 939–948 (2021).
Google Scholar
Murray, A. K. et al. Novel insights into selection for antibiotic resistance in complex microbial communities. mBio (2018).
Klümper, U. et al. Selection for antimicrobial resistance is reduced when embedded in a natural microbial community. ISME J. 13, 2927–2937 (2019).
Google Scholar
Perron, G. G., Gonzalez, A. & Buckling, A. Source–sink dynamics shape the evolution of antibiotic resistance and its pleiotropic fitness cost. Proc. Biol. Soc. 274, 2351–2356 (2007).
Partridge, S. R., Kwong, S. M., Firth, N. & Jensen, S. O. Mobile genetic elements associated with antimicrobial resistance. Clin. Microbiol. Rev. (2018).
Liu, G., Thomsen, L. E. & Olsen, J. E. Antimicrobial-induced horizontal transfer of antimicrobial resistance genes in bacteria: a mini-review. J. Antimicrob. Chemother. 77, 556–567 (2022).
Google Scholar
Baquero, F. et al. Evolutionary pathways and trajectories in antibiotic resistance. Clin. Microbiol. Rev. (2021).
Søgaard Jørgensen, P. et al. Evolution of the polycrisis: Anthropocene traps that challenge global sustainability. Philos. Trans. R. Soc. Lond. B 379, 20220261 (2023).
Google Scholar
The Global Risks Report 2023 (World Economic Forum, 2023).
IPCC Climate Change 2021: The Physical Science Basis (eds Masson-Delmotte, V. et al.) (Cambridge Univ. Press, 2023); https://doi.org/10.1017/9781009157896
McGough, S. F., MacFadden, D. R., Hattab, M. W., Mølbak, K. & Santillana, M. Rates of increase of antibiotic resistance and ambient temperature in Europe: a cross-national analysis of 28 countries between 2000 and 2016. Eurosurveillance 25, 1900414 (2020).
Google Scholar
MacFadden, D. R., McGough, S. F., Fisman, D., Santillana, M. & Brownstein, J. S. Antibiotic resistance increases with local temperature. Nat. Clim. Change 8, 510–514 (2018).
Google Scholar
Semenza, J. C. & Ko, A. I. Waterborne diseases that are sensitive to climate variability and climate change. N. Engl. J. Med. 389, 2175–2187 (2023).
Google Scholar
Meinen, A. et al. Antimicrobial resistance in Germany and Europe – a systematic review on the increasing threat accelerated by climate change. J. Health Monit. (2023).
Watson, J. T., Gayer, M. & Connolly, M. A. Epidemics after natural disasters. Emerg. Infect. Dis. (2007).
Cotugno, S. et al. Antimicrobial resistance and migration: interrelation between two hot topics in global health. Ann. Glob. Health 91, 12 (2025).
Google Scholar
Costescu Strachinaru, D. I. et al. Management and prevention of multidrug-resistant bacteria in war casualties. Trop. Med. Infect. Dis. 10, 128 (2025).
Google Scholar
Kumar, R. et al. Antimicrobial resistance in a protracted war setting: a review of the literature from Palestine. mSystems (2025).
Lee, J., Beck, K. & Bürgmann, H. Wastewater bypass is a major temporary point-source of antibiotic resistance genes and multi-resistance risk factors in a Swiss river. Water Res. 208, 117827 (2022).
Google Scholar
Andrade, L., O’Dwyer, J., O’Neill, E. & Hynds, P. Surface water flooding, groundwater contamination, and enteric disease in developed countries: a scoping review of connections and consequences. Environ. Pollut. 236, 540–549 (2018).
Google Scholar
Pérez-Valdespino, A., Pircher, R., Pérez-Domínguez, C. Y. & Mendoza-Sanchez, I. Impact of flooding on urban soils: changes in antibiotic resistance and bacterial community after Hurricane Harvey. Sci. Total Environ. 766, 142643 (2021).
Google Scholar
Delpla, I., Jung, A.-V., Baures, E., Clement, M. & Thomas, O. Impacts of climate change on surface water quality in relation to drinking water production. Environ. Int. 35, 1225–1233 (2009).
Google Scholar
Fu, Y. et al. Gut microbiota research nexus: One Health relationship between human, animal, and environmental resistomes. mLife 2, 350–364 (2023).
Google Scholar
Fackelmann, G. et al. Human encroachment into wildlife gut microbiomes. Commun. Biol. 4, 800 (2021).
Google Scholar
Li, Z. et al. Climate warming increases the proportions of specific antibiotic resistance genes in natural soil ecosystems. J. Hazard. Mater. 430, 128442 (2022).
Google Scholar
Collignon, P., Beggs, J. J., Walsh, T. R., Gandra, S. & Laxminarayan, R. Anthropological and socioeconomic factors contributing to global antimicrobial resistance: a univariate and multivariable analysis. Lancet Planet. Health 2, e398–e405 (2018).
Google Scholar
Nguyen-Thanh, L., Wernli, D., Målqvist, M., Graells, T. & Jørgensen, P. S. Characterising proximal and distal drivers of antimicrobial resistance: an umbrella review. J. Glob. Antimicrob. Resist. 36, 50–58 (2024).
Google Scholar
United Nations Department of Economic and Social Affairs The Sustainable Development Goals Report 2023: Special Edition (United Nations, 2023); https://doi.org/10.18356/9789210024914
Lewnard, J. A. et al. Burden of bacterial antimicrobial resistance in low-income and middle-income countries avertible by existing interventions: an evidence review and modelling analysis. Lancet 403, 2439–2454 (2024).
Google Scholar
Miller, W. R. & Arias, C. A. ESKAPE pathogens: antimicrobial resistance, epidemiology, clinical impact and therapeutics. Nat. Rev. Microbiol. 22, 598–616 (2024).
Google Scholar
Ektefaie, Y., Dixit, A., Freschi, L. & Farhat, M. R. Globally diverse Mycobacterium tuberculosis resistance acquisition: a retrospective geographical and temporal analysis of whole genome sequences. Lancet Microbe 2, e96–e104 (2021).
Google Scholar
G20 call to action on antimicrobial resistance. G7G20 Documents Database (2022).
Baym, M., Stone, L. K. & Kishony, R. Multidrug evolutionary strategies to reverse antibiotic resistance. Science 351, aad3292 (2016).
Google Scholar
Regulation (EU) 2019/6 of the European Parliament and of the Council of 11 December 2018 on veterinary medicinal products and repealing Directive 2001/82/EC. EUR-Lex (2018).
Robinson, T. P. et al. Antibiotic resistance: mitigation opportunities in livestock sector development. Animal 11, 1–3 (2017).
Google Scholar
Klümper, U. et al. Environmental microbiome diversity and stability is a barrier to antimicrobial resistance gene accumulation. Commun. Biol. 7, 706 (2024).
Google Scholar
Pastor-López, E. J. et al. Potential of nature-based solutions to reduce antibiotics, antimicrobial resistance, and pathogens in aquatic ecosystems. A critical review. Sci. Total Environ. 946, 174273 (2024).
Google Scholar
United Nations Environment Programme Bracing for Superbugs: Strengthening Environmental Action in the One Health Response to Antimicrobial Resistance (United Nations, 2023); https://doi.org/10.18356/9789210025799
About the National Antimicrobial Resistance Monitoring System (NARMS). CDC (2024).
Pärnänen, K. M. M. et al. Antibiotic resistance in European wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence. Sci. Adv. 5, eaau9124 (2019).
Google Scholar
Clarke, L. M., O’Brien, J. W., Murray, A. K., Gaze, W. H. & Thomas, K. V. A review of wastewater-based epidemiology for antimicrobial resistance surveillance. J. Environ. Expo. Assess. 3, 7 (2024).
Google Scholar
Matheu, J., Aidara-Kane, A. & Andremont, A. The ESBL tTricycle AMR surveillance project: a simple, One Health approach to global surveillance. AMR Control (2017).
Liguori, K., Davis, B., Milligan, E., Calarco, J. & Keenum, I. Standardizing Methods with QA/QC Standards for Investigating the Occurrence and Removal of Antibiotic Resistant Bacteria/Antibiotic Resistance Genes (ARB/ARGs) in Surface Water, Wastewater, and Recycled Water (Water Research Foundation, 2023).
Directive of the European Parliament and of the Council concerning urban wastewater treatment (recast). EUR-Lex (2022).
Becerra-Castro, C. et al. Wastewater reuse in irrigation: a microbiological perspective on implications in soil fertility and human and environmental health. Environ. Int. 75, 117–135 (2015).
Google Scholar
Chojnacka, K. et al. A transition from conventional irrigation to fertigation with reclaimed wastewater: prospects and challenges. Renew. Sustain. Energy Rev. 130, 109959 (2020).
Google Scholar
Keenum, I. et al. Metagenomic tracking of antibiotic resistance genes through a pre-harvest vegetable production system: an integrated lab-, microcosm- and greenhouse-scale analysis. Environ. Microbiol. 24, 3705–3721 (2022).
Google Scholar
Quon, H. & Jiang, S. Quantitative microbial risk assessment of antibiotic-resistant E. coli, Legionella pneumophila, and Mycobacteria in nonpotable wastewater reuse applications. Environ. Sci. Technol. (2024).
Craddock, H. A. et al. Antibiotic-resistant Escherichia coli and Klebsiella spp. in greywater reuse systems and pond water used for agricultural irrigation in the West Bank, Palestinian Territories. Environ. Res. 188, 109777 (2020).
Google Scholar
Regulation (EU) 2020/741 of the European Parliament and of the Council of 25 May 2020 on minimum requirements for water reuse. EUR-Lex (2020).
Manyi-Loh, C., Mamphweli, S., Meyer, E. & Okoh, A. Antibiotic use in agriculture and its consequential resistance in environmental sources: potential public health implications. Molecules 23, 795 (2018).
Google Scholar
Muurinen, J. et al. Biological units of antimicrobial resistance and strategies for their containment in animal production. FEMS Microbiol. Ecol. 98, fiac060 (2022).
Google Scholar
Velazquez-Meza, M. E., Galarde-López, M., Carrillo-Quiróz, B. & Alpuche-Aranda, C. M. Antimicrobial resistance: One Health approach. Vet. World 15, 743–749 (2022).
Google Scholar
Lambraki, I. A. et al. Factors influencing antimicrobial resistance in the European food system and potential leverage points for intervention: a participatory, One Health study. PLoS ONE 17, e0263914 (2022).
Google Scholar
Library of AMR national action plans. World Health Organization (2025).
Ferreira, J. P. et al. Achieving antimicrobial stewardship on the global scale: challenges and opportunities. Microorganisms 10, 1599 (2022).
Google Scholar
Cullet, P. & Bhullar, L. The regulation of planetary health challenges: a co-benefits approach for AMR and WASH. Environ. Policy Law 52, 289–299 (2022).
Google Scholar
Zhou, Z. et al. Co-benefits of antimicrobial resistance mitigation from China’s PM2.5 air pollution reduction between 2014–2020. Engineering 45, 243–251 (2025).
Google Scholar
Lopes Antunes, A. C. & Jensen, V. F. Close to a decade of decrease in antimicrobial usage in Danish pig production–evaluating the effect of the Yellow Card scheme. Front. Vet. Sci. 7, 109 (2020).
Google Scholar
Bhullar, L. Green public procurement of pharmaceuticals as a regulatory response to antimicrobial resistance and its compatibility with the WTO Agreement on Government Procurement. Rev. Eur. Comp. Int. Environ. Law 33, 291–302 (2024).
Google Scholar
Arredondo-Alonso, S. et al. Plasmid-driven strategies for clone success in Escherichia coli. Nat. Commun. 16, 2921 (2025).
Google Scholar
Hernandez-Beltran, J. C. R. et al. Plasmid-mediated phenotypic noise leads to transient antibiotic resistance in bacteria. Nat. Commun. 15, 2610 (2024).
Google Scholar
Ebmeyer, S., Kristiansson, E. & Larsson, D. G. J. A framework for identifying the recent origins of mobile antibiotic resistance genes. Commun. Biol. 4, 8 (2021).
Google Scholar
link
