Ye Zehong, Li Menghan, Jing Yiwen, Liu Kejun, Wu Yongning, Peng Zixin
School of Public Health, Shandong Second Medical University, Weifang 261053, China.
NHC Key Laboratory of Food Safety Risk Assessment, Chinese Academy of Medical Science Research Unit (2019RU014), China National Center for Food Safety Risk Assessment, Beijing 100021, China.
Antibiotics (Basel). 2025 May 26;14(6):543. doi: 10.3390/antibiotics14060543.
Antimicrobial resistance (AMR) has emerged as a critical global public health threat, exacerbating healthcare burdens and imposing substantial economic costs. Currently, AMR contributes to nearly five million deaths annually worldwide, surpassing mortality rates of any single infectious disease. The economic burden associated with AMR-related disease management is estimated at approximately $730 billion per year. This review synthesizes current research on the mechanisms and multifaceted drivers of AMR development and dissemination through the lens of the One Health framework, which integrates human, animal, and environmental health perspectives. Intrinsic factors, including antimicrobial resistance genes (ARGs) and mobile genetic elements (MGEs), enable bacteria to evolve adaptive resistance mechanisms such as enzymatic inactivation, efflux pumps, and biofilm formation. Extrinsic drivers span environmental stressors (e.g., antimicrobials, heavy metals, disinfectants), socioeconomic practices, healthcare policies, and climate change, collectively accelerating AMR proliferation. Horizontal gene transfer and ecological pressures further facilitate the spread of antimicrobial-resistant bacteria across ecosystems. The cascading impacts of AMR threaten human health and agricultural productivity, elevate foodborne infection risks, and impose substantial economic burdens, particularly in low- and middle-income countries. To address this complex issue, the review advocates for interdisciplinary collaboration, robust policy implementation (e.g., antimicrobial stewardship), and innovative technologies (e.g., genomic surveillance, predictive modeling) under the One Health paradigm. Such integrated strategies are essential to mitigate AMR transmission, safeguard global health, and ensure sustainable development.
抗菌药物耐药性（AMR）已成为全球公共卫生的重大威胁，加剧了医疗负担并带来了巨大的经济成本。目前，AMR每年在全球导致近500万人死亡，超过任何一种单一传染病的死亡率。与AMR相关疾病管理相关的经济负担估计每年约为7300亿美元。本综述通过“同一健康”框架，综合了当前关于AMR产生和传播的机制及多方面驱动因素的研究，该框架整合了人类、动物和环境卫生等方面的观点。内在因素，包括抗菌耐药基因（ARGs）和可移动遗传元件（MGEs），使细菌能够进化出适应性耐药机制，如酶失活、外排泵和生物膜形成。外在驱动因素包括环境压力源（如抗菌药物、重金属、消毒剂）、社会经济实践、医疗政策和气候变化，这些因素共同加速了AMR的扩散。水平基因转移和生态压力进一步促进了抗菌耐药细菌在生态系统中的传播。AMR的连锁反应威胁着人类健康和农业生产力，增加了食源性感染风险，并带来了巨大的经济负担，特别是在低收入和中等收入国家。为解决这一复杂问题，本综述倡导在“同一健康”范式下进行跨学科合作、有力地实施政策（如抗菌药物管理）以及采用创新技术（如基因组监测、预测建模）。此类综合策略对于减轻AMR传播、保障全球健康和确保可持续发展至关重要。
