Interconnections between the food system and antimicrobial resistance: A systems-informed umbrella review from a One Health perspective

This umbrella review examines antimicrobial resistance (AMR) in human food systems through a complex systems lens. Synthesizing 80 systematic reviews, it shows that AMR emerges from interconnected factors spanning human, animal, and environmental reservoirs. Antimicrobial use in livestock is a central driver, shaped by trade-offs between animal health, welfare, and farm economics. Evidence highlights feedback loops enabling AMR transmission across reservoirs, with consequences for human, animal, and crop health as well as farm viability. The review emphasizes the need for a One Health approach and calls for further research on upstream drivers such as consumer behavior and environmental factors.