Defining and combating antibiotic resistance from One Health and Global Health perspectives

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Several interconnected human, animal and environmental habitats can contribute to the emergence, evolution and spread of antibiotic resistance, and the health of these contiguous habitats (the focus of the One Health approach) may represent a risk to human health. Additionally, the expansion of resistant clones and antibiotic resistance determinants among human-associated, animal-associated and environmental microbiomes have the potential to alter bacterial population genetics at local and global levels, thereby modifying the structure, and eventually the productivity, of microbiomes where antibiotic-resistant bacteria can expand. Conversely, any change in these habitats (including pollution by antibiotics or by antibiotic-resistant organisms) may influence the structures of their associated bacterial populations, which might affect the spread of antibiotic resistance to, and among, the above-mentioned microbiomes. Besides local transmission among connected habitats—the focus of studies under the One Health concept—the transmission of resistant microorganisms might occur on a broader (even worldwide) scale, requiring coordinated Global Health actions. This Review provides updated information on the elements involved in the evolution and spread of antibiotic resistance at local and global levels, and proposes studies to be performed and strategies to be followed that may help reduce the burden of antibiotic resistance as well as its impact on human and planetary health.

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Fig. 1: The One Health and global Health axes of antibiotic resistance.
Fig. 2: The hierarchy and spread of antibiotic resistance.


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J.L.M. is supported by grants from the Instituto de Salud Carlos III (grant no. RD16/0016/0011)—co-financed by the European Development Regional Fund ‘A Way to Achieve Europe’ (grant no. S2017/BMD-3691); InGEMICS-CM, funded by Comunidad de Madrid (Spain) and European Structural and Investment Funds; and by the Spanish Ministry of Economy and Competitivity (grant no. BIO2017-83128-R). T.M.C. and F.B. are supported by the Joint Programming Initiative on Antimicrobial Resistance (grant nos. ST131 JPIAMR2016-AC16/00036 and JPIAMR2016-AC16/00039), the European Development Regional Fund ‘A Way to Achieve Europe’ for co-funding the Spanish R&D National Plan 2012–2019 (grant nos. P15-1581 and PI18-1942), the CIBER (CIBER in Epidemiology and Public Health; grant no. CB06/02/0053), the Regional Government of Madrid (InGeMICS B2017/BMD-3691) and the Fundación Ramón Areces.

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Correspondence to José L. Martínez.

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