Sassi Asma, Basher Nosiba S, Kirat Hassina, Meradji Sameh, Ibrahim Nasir Adam, Idres Takfarinas, Touati Abdelaziz
Laboratory of Microbiology and Molecular Biology, Departement of Biochemistry, Faculty of Sciences, Badji Mokhtar University, Annaba 23000, Algeria.
Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13318, Saudi Arabia.
Antibiotics (Basel). 2025 Jul 29;14(8):764. doi: 10.3390/antibiotics14080764.
Antimicrobial resistance (AMR) has emerged as a planetary health emergency, driven not only by the clinical misuse of antibiotics but also by diverse environmental dissemination pathways. This review critically examines the role of environmental compartments-water, soil, and air-as dynamic reservoirs and transmission routes for antibiotic-resistant bacteria (ARB) and resistance genes (ARGs). Recent metagenomic, epidemiological, and mechanistic evidence demonstrates that anthropogenic pressures-including pharmaceutical effluents, agricultural runoff, untreated sewage, and airborne emissions-amplify resistance evolution and interspecies gene transfer via horizontal gene transfer mechanisms, biofilms, and mobile genetic elements. Importantly, it is not only highly polluted rivers such as the Ganges that contribute to the spread of AMR; even low concentrations of antibiotics and their metabolites, formed during or after treatment, can significantly promote the selection and dissemination of resistance. Environmental hotspots such as European agricultural soils and airborne particulate zones near wastewater treatment plants further illustrate the complexity and global scope of pollution-driven AMR. The synergistic roles of co-selective agents, including heavy metals, disinfectants, and microplastics, are highlighted for their impact in exacerbating resistance gene propagation across ecological and geographical boundaries. The efficacy and limitations of current mitigation strategies, including advanced wastewater treatments, thermophilic composting, biosensor-based surveillance, and emerging regulatory frameworks, are evaluated. By integrating a One Health perspective, this review underscores the imperative of including environmental considerations in global AMR containment policies and proposes a multidisciplinary roadmap to mitigate resistance spread across interconnected human, animal, and environmental domains.
抗菌药物耐药性（AMR）已成为一场全球卫生突发事件，其驱动因素不仅包括抗生素在临床中的滥用，还包括多种环境传播途径。本综述批判性地审视了环境介质（水、土壤和空气）作为抗生素耐药菌（ARB）和耐药基因（ARGs）的动态储存库及传播途径所起的作用。最近的宏基因组学、流行病学和机制研究证据表明，人为压力（包括制药废水、农业径流、未经处理的污水和空气传播排放物）通过水平基因转移机制、生物膜和移动遗传元件，加剧了耐药性进化和种间基因转移。重要的是，不仅像恒河这样污染严重的河流会导致AMR的传播；即使是在处理过程中或处理后形成的低浓度抗生素及其代谢产物，也能显著促进耐药性的选择和传播。欧洲农业土壤和污水处理厂附近的空气颗粒物区域等环境热点进一步说明了污染驱动的AMR的复杂性和全球范围。强调了共选剂（包括重金属、消毒剂和微塑料）在加剧耐药基因跨越生态和地理边界传播方面的协同作用。评估了当前缓解策略（包括先进的废水处理、高温堆肥、基于生物传感器的监测和新兴监管框架）的有效性和局限性。通过整合“同一健康”视角，本综述强调了在全球AMR控制政策中纳入环境考量的紧迫性，并提出了一个多学科路线图，以减轻耐药性在相互关联的人类、动物和环境领域的传播。
