Antimicrobial resistance within the one health lens: global drivers, mechanisms and public health policy gaps in low resource settings

Nathan Mugenyi, Ronald Omolo Ouma, Mohamed Mustaf Ahmed, Don Eliseo Lucero‐Prisno

Background Antimicrobial resistance (AMR) poses a significant threat to global healthcare systems in terms of poor clinical outcomes, reduced quality of life and economic burdens. It is therefore imperative to comprehend the impact of all One Health domains, such as humans, livestock, agriculture and ecosystems in the fight against AMR. This narrative review therefore aims to highlight the resistance mechanisms, AMR global burden and its contributing factors. Additionally, this review identifies currently existing information gaps, monitoring parameters and global AMR mitigation strategies. Methods A structured literature search was conducted across multiple electronic databases, including PubMed, EMBASE, ScienceDirect, the Cochrane Library, and Google Scholar to identify relevant peer-reviewed studies on antimicrobial resistance (AMR). The search included articles published in English between January 2013 and January 2025. Additional references were identified through manual screening of reference lists and relevant global reports from organizations such as the World Health Organization (WHO) and the Global Antimicrobial Resistance and Use Surveillance System (GLASS). Studies were eligible for inclusion if they addressed AMR in human health, animal health, agriculture, food systems and environmental settings within a One Health framework with particular emphasis on low- and middle-income countries (LMICs) as classified by the World Bank. Articles focusing on AMR mechanisms, transmission pathways, surveillance systems, AMS, environmental dissemination, and public health consequences were considered for inclusion. Results The review narrative identified five major themes: global AMR burden, resistance mechanisms, cross-sectoral drivers, surveillance gaps, and stewardship responses. Globally, AMR was linked to 4.95 million deaths in 2019, with 3.57 million deaths directly attributable to drug-resistant infections. The major pathogens included Escherichia coli , Klebsiella pneumoniae , and Staphylococcus aureus , which exhibited alarming resistance to last-line antibiotics. The overuse of antibiotics in healthcare and agriculture, poor sanitation, unchecked use of biocides and heavy metals, and weak AMR surveillance were identified as the principal drivers. Data from the WHO’s Global Antimicrobial Resistance Surveillance System (GLASS) confirmed the escalation of resistance among priority pathogens. Conclusion AMR is a multifaceted One Health challenge that requires urgent and integrated efforts to be mitigated. Strengthening integrated One Health surveillance, AMS, wastewater monitoring, and LMIC laboratory capacity should become immediate global policy priorities. Without immediate and sustained interventions, AMR threatens to reverse decades of medical progress and compromise the achievement of global health objectives. AMR is spreading globally due to irrational (un-judicious) antimicrobial use, cross-sectoral contamination, and the genetic exchange of resistance determinants among bacterial populations. Resistance gene transfer, particularly via horizontal mechanisms, is most pronounced where human, livestock, and environmental (One Health) interfaces overlap.