Clifford Astbury Chloe, Hu Catherine, Sivapragasam Krishihan, Rajan Arabi, Geise Mandy, Aenishaenslin Cécile, Ruckert Arne, Togño Kathleen Chelsea, Wiktorowicz Mary, Penney Tarra L
School of Global Health, York University, Toronto, Ontario, Canada.
Dahdaleh Institute for Global Health Research, York University, Toronto, Ontario, Canada.
One Health. 2025 Jul 23;21:101143. doi: 10.1016/j.onehlt.2025.101143. eCollection 2025 Dec.
Human food systems are a major driver of antimicrobial resistance (AMR), with significant implications for human, animal, and ecosystem health. While recent research frames AMR as an emerging property of a complex system, this perspective has not been systematically applied to the existing evidence. This review aims to synthesise the evidence on AMR and the food system from a complex systems perspective, highlighting the interconnections between factors that contribute to AMR emergence and spread.
An umbrella review methodology was used to identify relevant studies. We searched Medline, SCOPUS, Agricola, and Dimensions using terms related to AMR and the food system. Systematic reviews at this intersection containing evidence of at least one relationship between two variables were included. Data were extracted and summarised according to umbrella review guidelines, and a causal loop diagram (CLD) was developed to map the interrelationships between food system factors and AMR.
Our synthesis incorporated evidence from 80 studies, highlighting how AMR emergence and spread within food systems is driven by a complex interplay of factors across human, animal, and environmental reservoirs (e.g., water, soil), with impacts for disease burden in humans, animals and crops and financial viability of farming. The tensions driving antimicrobial use (AMU) in livestock, a key driver of AMR, were underlined, with trade-offs between disease treatment, animal welfare, and economic outcomes. Feedback loops between humans, animals, and the environment were identified, with antimicrobials and AMR spreading between multiple reservoirs.
This review underscores the need for a One Health approach to AMR mitigation, given the interconnections between human, animal, and ecosystem health. Findings highlight the trade-offs in AMU and the economic incentives that may conflict with global antimicrobial stewardship. Further research may empirically explore connections to upstream factors, such as consumer preferences and environmental determinants.
人类食物系统是抗微生物药物耐药性（AMR）的主要驱动因素，对人类、动物和生态系统健康具有重大影响。虽然最近的研究将AMR视为复杂系统的一种新兴属性，但这一观点尚未系统地应用于现有证据。本综述旨在从复杂系统的角度综合关于AMR和食物系统的证据，突出导致AMR出现和传播的因素之间的相互联系。
采用综合综述方法来识别相关研究。我们使用与AMR和食物系统相关的术语在Medline、SCOPUS、Agricola和Dimensions数据库中进行检索。纳入在这个交叉领域包含两个变量之间至少一种关系证据的系统综述。根据综合综述指南提取和总结数据，并绘制因果循环图（CLD）以描绘食物系统因素与AMR之间的相互关系。
我们的综合分析纳入了80项研究的证据，突出了食物系统中AMR的出现和传播是如何由人类、动物和环境储存库（如水、土壤）中的多种因素复杂相互作用驱动的，对人类、动物和作物的疾病负担以及农业的经济可行性产生影响。强调了推动牲畜使用抗微生物药物（AMU）这一AMR关键驱动因素的紧张关系，以及疾病治疗、动物福利和经济结果之间的权衡。识别出人类、动物和环境之间的反馈循环，抗微生物药物和AMR在多个储存库之间传播。
鉴于人类、动物和生态系统健康之间的相互联系，本综述强调了采用“同一个健康”方法来缓解AMR的必要性。研究结果突出了AMU中的权衡以及可能与全球抗微生物药物管理相冲突的经济激励因素。进一步的研究可以实证探索与上游因素的联系，如消费者偏好和环境决定因素。
