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Antimicrobial resistance in aquatic ecosystems: Sources, transmission pathways, ecological impacts, and mitigation strategies
Summary
This review pulls together existing research showing that rivers, lakes, and wastewater aren't just passive dumping grounds for antibiotics and drug-resistant bacteria—they're actually breeding grounds where these germs mix, swap resistance traits, and become even harder to treat, especially when microplastics and other pollutants are present alongside antibiotics. This matters because these "supercharged" resistant bacteria can reach you through drinking water, seafood, or swimming, making common infections harder to cure with standard antibiotics. The authors argue that better wastewater treatment and pollution control are key to slowing this spread before it further thre
Antimicrobial resistance (AMR) has emerged as one of the most critical global health and environmental challenges of the twenty-first century, with aquatic ecosystems increasingly recognized as important reservoirs and dissemination pathways for antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARGs), and mobile genetic elements (MGEs). Aquatic environments receive continuous inputs of antibiotics and resistant microorganisms from anthropogenic activities, including municipal wastewater discharge, hospital effluents, agricultural runoff, livestock production, aquaculture practices, and pharmaceutical manufacturing. The persistence of these contaminants in water columns, sediments, and biofilms creates selective pressure that promotes the maintenance, evolution, and horizontal transfer of resistance determinants among diverse microbial communities. Furthermore, the coexistence of antibiotics with heavy metals, disinfectants, microplastics, and other environmental pollutants enhances co-selection processes and accelerates the emergence of multidrug-resistant microorganisms. Aquatic ecosystems therefore function not only as passive reservoirs but also as active evolutionary hotspots facilitating resistance dissemination across environmental, animal, and human interfaces. Transmission of resistant bacteria and ARGs may occur through drinking water, seafood consumption, recreational activities, and occupational exposure, highlighting the importance of the One Health perspective in understanding environmental AMR dynamics. This review comprehensively examines the major sources, transmission mechanisms, ecological consequences, public health implications, and mitigation strategies associated with AMR in aquatic ecosystems. Strengthening environmental surveillance, improving wastewater management, promoting sustainable aquaculture practices, and implementing integrated One Health interventions are essential for mitigating the global spread of antimicrobial resistance and protecting ecosystem and public health.