Environmental antimicrobial resistance and its drivers: A potential threat to public health.

Imprudent and overuse of clinically relevant antibiotics in agriculture, veterinary, and medical settings contribute to the global epidemic scenario of Antimicrobial Resistance (AMR). There is a growing concern among researchers and stakeholders that the environment has been implicated as an AMR reservoir and plays a key role in the dissemination of antimicrobial resistance-associated genes. The drivers are contributing factors for the spread of resistant bacteria or their resistant genes either directly through antimicrobial drugs used in health care, agriculture/livestock, and environment or antibiotic residues released from various domestic settings. The resistant microorganisms and their resistance genes enter the soil, air, water, and sediments through various routes or hotspots such as hospital wastewater, agricultural waste, or wastewater treatment plants (WWTPs). The global mitigation strategies primarily involve the identification of high-risk environments that are responsible for the evolution and spread of resistance. Subsequently, AMR transmission is affected by the standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. This review provides a brief description of AMR as a global concern and the possible contribution of different environmental drivers in the transmission of antibiotic-resistant bacteria or resistant genes through various mechanisms. We also aim to highlight the key knowledge gaps that hinder the environmental regulators and mitigation strategies in delivering environmental protection against AMR.