Abstract / Summary
Antibiotic resistance (ABR) is a major global health threat. Beyond inappropriate clinical use, its emergence and persistence are influenced by complex interactions across humans, animals and the environment, demanding a One Health perspective. To investigate these dynamics, we conducted an ecological study on 397,103 isolates of Escherichia coli and Shigella spp. and Salmonella enterica collected from human, animal, and environmental sources in 102 countries between 2003 and 2018, using the NCBI Pathogen Detection database. Genotypically-inferred resistance to seven major antibiotic classes (tetracyclines, sulfonamides, trimethoprim, phenicols, aminoglycosides, β-lactams, and cephalosporins) was determined based on the presence of corresponding antimicrobial resistance genes in the bacterial genomes. We used mixed-effects negative binomial models to examine associations between genotypically inferred antibiotic resistance and socioeconomic, environmental, and livestock-related factors across both bacterial species, using all-sources and source-stratified isolates. Our results reveal species-specific associations. Genotypically-inferred resistance in E. coli and Shigella spp. was primarily associated with anthropogenic factors such as low income (e.g. tetracycline PRR; 95% CI: 0.62; 0.49–0.79), high population density, and PM 2.5 exposure (e.g. β-lactams PRR; 95% CI: 1.39; 1.11–1.74). In contrast, S. enterica resistance was mainly associated with environmental and livestock-related factors, including warmer climates (e.g. sulphonamides PRR; 95% CI: 1.92; 0.96–3.85), PM 2.5 exposure (e.g. tetracyclines PRR; 95% CI: 1.65; 0.98–2.76), and high poultry density (e.g. aminoglycosides PRR; 95% CI: 1.78; 1.14–2.78). Our findings highlight the need for a One Health approach when addressing ABR, integrating human, animal, and environmental data to capture species-specific associations across interconnected ecosystems.