An Overview of the Recent Advances in Antimicrobial Resistance

Abstract

Antimicrobial resistance (AMR), frequently considered a major global public health threat, requires a comprehensive understanding of its emergence, mechanisms, advances, and implications. AMR's epidemiological landscape is characterized by its widespread prevalence and constantly evolving patterns, with multidrug-resistant organisms (MDROs) creating new challenges every day. The most common mechanisms underlying AMR (i.e., genetic mutations, horizontal gene transfer, and selective pressure) contribute to the emergence and dissemination of new resistant strains. Therefore, mitigation strategies (e.g., antibiotic stewardship programs-ASPs-and infection prevention and control strategies-IPCs) emphasize the importance of responsible antimicrobial use and surveillance. A One Health approach (i.e., the interconnectedness of human, animal, and environmental health) highlights the necessity for interdisciplinary collaboration and holistic strategies in combating AMR. Advancements in novel therapeutics (e.g., alternative antimicrobial agents and vaccines) offer promising avenues in addressing AMR challenges. Policy interventions at the international and national levels also promote ASPs aiming to regulate antimicrobial use. Despite all of the observed progress, AMR remains a pressing concern, demanding sustained efforts to address emerging threats and promote antimicrobial sustainability. Future research must prioritize innovative approaches and address the complex socioecological dynamics underlying AMR. This manuscript is a comprehensive resource for researchers, policymakers, and healthcare professionals seeking to navigate the complex AMR landscape and develop effective strategies for its mitigation.

Keywords: One Health approach; antibiotic stewardship programs; antimicrobial resistance; epidemiology; mechanisms; novel therapeutics; policy interventions.

Figure 1

Schematic representation of antimicrobial use in agriculture and animal and human health and the flux of these drugs among all counterparts.

Figure 2

Schematic representation of the flowchart of the searched articles and the inclusion and exclusion criteria.

Figure 3

Global distribution of the main multi-resistant strains and antimicrobial resistance (CD: Clostridium difficile; CRE: carbapenem-resistant Enterobacterales; ESBL: extended-spectrum beta-lactamase; MRSA: methicillin-resistant Staphylococcus aureus; VRE: vancomycin-resistant Enterococcus; TB: multidrug-resistant Mycobacterium tuberculosis).

Figure 4

Effective IPC strategies to prevent MDRO emergence and dissemination.