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Healthcare as a driver, reservoir and amplifier of antimicrobial resistance: opportunities for interventions

Nature Reviews Microbiology volume 22, pages 636–649 (2024)Cite this article

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Abstract

Antimicrobial resistance (AMR) is a global health challenge that threatens humans, animals and the environment. Evidence is emerging for a role of healthcare infrastructure, environments and patient pathways in promoting and maintaining AMR via direct and indirect mechanisms. Advances in vaccination and monoclonal antibody therapies together with integrated surveillance, rapid diagnostics, targeted antimicrobial therapy and infection control measures offer opportunities to address healthcare-associated AMR risks more effectively. Additionally, innovations in artificial intelligence, data linkage and intelligent systems can be used to better predict and reduce AMR and improve healthcare resilience. In this Review, we examine the mechanisms by which healthcare functions as a driver, reservoir and amplifier of AMR, contextualized within a One Health framework. We also explore the opportunities and innovative solutions that can be used to combat AMR throughout the patient journey. We provide a perspective on the current evidence for the effectiveness of interventions designed to mitigate healthcare-associated AMR and promote healthcare resilience within high-income and resource-limited settings, as well as the challenges associated with their implementation.

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Fig. 1: Healthcare as a driver of antimicrobial resistance.
Fig. 2: The use of vaccines and immunotherapy to reduce antimicrobial-resistance and protect healthcare.
Fig. 3: The power of artificial intelligence and data-linkage technology to reduce antimicrobial resistance and improve healthcare resilience.

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Acknowledgements

The authors gratefully acknowledge the David Price Evans Endowment fund and thank the members of the Centre for Antimicrobial Optimisation Network (CAMO-Net) for the helpful discussions. CAMO-Net is a global research partnership funded by the Wellcome Trust (grant ref. 226691/Z/22/Z). Research in the laboratories of the authors was also partially funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with the UK Health Security Agency (previously PHE) in collaboration with Imperial Healthcare Partners, University of Cambridge and University of Warwick. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or the UK Health Security Agency. G.B. contributed to this work as part of the COMBINE research programme, which benefited from a government grant managed by the Agence Nationale de la Recherche under the Programme France 2030 with the reference ANR 22 PAMR 0003.

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  1. These authors contributed equally: Derek Cocker, Gabriel Birgand.

Authors and Affiliations

  1. David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK

    Derek Cocker & Alison Holmes

  2. Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi

    Derek Cocker & Kondwani Jambo

  3. Centre d’appui pour la Prévention des Infections Associées aux Soins, Nantes, France

    Gabriel Birgand

  4. National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK

    Gabriel Birgand, Nina Zhu, Jesus Rodriguez-Manzano, Raheelah Ahmad & Alison Holmes

  5. Cibles et medicaments des infections et de l’immunitée, IICiMed, Nantes Universite, Nantes, France

    Gabriel Birgand

  6. Department of Infectious Disease, Imperial College London, London, UK

    Nina Zhu, Jesus Rodriguez-Manzano & Alison Holmes

  7. Department of Health Services Research & Management, City University of London, London, UK

    Raheelah Ahmad

  8. Dow University of Health Sciences, Karachi, Pakistan

    Raheelah Ahmad

  9. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK

    Kondwani Jambo

  10. Department of Infectious Disease, School of Medicine & Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil

    Anna S. Levin

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Contributions

D.C., G.B., J.R.-M., N.Z., R.A. and A.H. contributed to the discussion, research, writing, and reviewing and editing of this manuscript. K.J. and A.S.L. contributed to discussion, writing, and reviewing and editing of the manuscript before submission.

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Cocker, D., Birgand, G., Zhu, N. et al. Healthcare as a driver, reservoir and amplifier of antimicrobial resistance: opportunities for interventions. Nat Rev Microbiol 22, 636–649 (2024). https://doi.org/10.1038/s41579-024-01076-4

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