Emergence of environmental antibiotic resistance: Mechanism, monitoring and management

Abstract

The rapid development and spread of antimicrobial resistance in the post-antibiotic era has become a global concern. Recent evidence indicates that, at present, antibiotic resistance is evolving at an alarming rate as a defense mechanism against anthropogenic chemical stresses. Mechanistically, bacterial resistance to antibiotics involves reduced permeability, active efflux, modification of the target site, and/or inactivation of the antibiotic molecule and is encoded by antibiotic resistance genes (ARGs) that are majorly carried by mobile genetic elements (MGEs). Horizontal gene transfer (HGT) facilitates the inter and intra-species dissemination of MGEs and drives the spread of ARGs, which leads to the development of environmental resistome. Clinical and environmental antibiotic resistance has severe consequences on global health and the economy if left unchecked. For routine monitoring of the resistance, traditional culture-based methods, reliable polymerase chain reaction (PCR)-based methods, in addition to recent high throughput and rapid next-generation sequencing (NGS)-based methods, are often used. The present work critically reviews the mechanisms for the evolution of antimicrobial resistance, tools to monitor the emergence of such resistance and the global efforts for management of the growing threat of antimicrobial resistance spearheaded by the World Health Organization (WHO) in collaboration with developed and developing countries alike. The work highlights the policies at global and national levels to monitor and implement stewardship programs, awareness campaigns, prevention practices, and healthcare guidelines to promote and ensure the judicious prescription of antimicrobials for the containment of antimicrobial resistance.

Keywords

• Antibiotic resistance
• HGT
• ARGs
• Management
• Surveillance
• Policies