Beyond human-centered surveillance: rethinking antimicrobial resistance monitoring in a One Health framework

Abstract

Antimicrobial resistance (AMR) challenges our collective capacity to respond effectively against bacterial pathogens. Regardless of the projections made for the coming years, trends consistently point upward in AMR levels worldwide and the loss of effective therapeutic options has shifted from a hypothetical threat to a tangible reality. In the context of human health, hospitals increasingly face pan-drug-resistant (PDR) microorganisms, while in the community, urinary tract infections (UTIs) are gradually more difficult to treat due to a rapid rise in antibiotic resistance. These findings raise serious concerns, as resistance to novel antibiotics that are not yet available in many countries is now being detected. In veterinary medicine, where therapeutic options are limited to preserve the availability of critical antimicrobials for human use, AMR poses both a clinical challenge (often limiting dequate treatment options) and an epidemiological one, as animals act as reservoirs of resistant bacteria and resistance genes transmissible to humans. Between these two domains, the environment (including water and soil) and wildlife complete and interconnect transmission cycles, reinforcing the systemic nature of AMR. It is therefore unsurprising that AMR constitutes a central pillar of the One Health paradigm and is globally addressed through the Quadripartite Alliance involving The World Health Organization (WHO), The World Organisation for Animal Health (WOAH), The Food and Agriculture Organization of the United Nations (FAO), and The United Nations Environment Programme (UNEP). From a human health perspective, the WHO promotes AMR surveillance through the Global Antimicrobial Resistance and Use Surveillance System (GLASS), which links resistance data from selected pathogens to specific clinical syndromes and diseases reported annually (https://www.who.int/initiatives/glass/resource-centre).