Environmental Antimicrobial Resistant Bacteria and Antibiotic Resistance Genes: The Environmental AMR Exposome

The paper conceptualizes antimicrobial resistance (AMR) as an environmental exposome, highlighting that antibiotic resistance genes (ARGs) and resistant bacteria are widely distributed across environmental compartments such as water, soil, and air, where they are continuously shaped by human activities including healthcare, agriculture, and pharmaceutical production. It identifies environmental “hotspots” like wastewater treatment plants and agricultural systems as key zones for the emergence and amplification of resistance, driven even by low (sub-inhibitory) concentrations of antibiotics and co-selective agents such as heavy metals. Central to this process is horizontal gene transfer via mobile genetic elements, enabling rapid spread of resistance across microbial populations and into human pathogens. The paper underscores that AMR is fundamentally a One Health issue, with environmental reservoirs feeding back into human health through water, food, and direct exposure, and argues that effective mitigation requires system-level interventions, including reducing environmental emissions, improving wastewater treatment, and integrating environmental surveillance into AMR policy.