Skip to main content Accessibility help

Antimicrobial resistance in human populations: challenges and opportunities

  • S. Allcock (a1) (a2), E. H. Young (a1) (a2), M. Holmes (a3), D. Gurdasani (a1) (a2), G. Dougan (a2), M. S. Sandhu (a1) (a2), L. Solomon (a4) and M. E. Török (a1) (a5) (a6)...
  • Please note a correction has been issued for this article.


Antimicrobial resistance (AMR) is a global public health threat. Emergence of AMR occurs naturally, but can also be selected for by antimicrobial exposure in clinical and veterinary medicine. Despite growing worldwide attention to AMR, there are substantial limitations in our understanding of the burden, distribution and determinants of AMR at the population level. We highlight the importance of population-based approaches to assess the association between antimicrobial use and AMR in humans and animals. Such approaches are needed to improve our understanding of the development and spread of AMR in order to inform strategies for the prevention, detection and management of AMR, and to support the sustainable use of antimicrobials in healthcare.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Antimicrobial resistance in human populations: challenges and opportunities
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Antimicrobial resistance in human populations: challenges and opportunities
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Antimicrobial resistance in human populations: challenges and opportunities
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

* Addresses for correspondence: Dr M. E. Török, Department of Medicine, University of Cambridge, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. (Email:
Dr Lulit Solomon, Park House, 116 Park Street, London, W1K 6AF, UK. (Email:


Hide All
1. World Health Organization. Antimicrobial resistance. 2015 [cited 2016 7 March]. (
2. World Health Organization. Antimicrobial Resistance: Global Report on Surveillance. Switzerland: World Health Organization, 2014.
3. World Health Organization. The Evolving Threat of Antimicrobial Resistance: Options for Action. Geneva: World Health Organization, 2012.
4. Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. 2014. (
5. Smith, R, Coast, J. The true cost of antimicrobial resistance. British Medical Journal 2013; 346: f1493.
6. Liu, YY, et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. The Lancet Infectious Diseases 2016; 16: 161168.
7. Holmes, AH, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 2015; 387: 176187.
8. Woolhouse, M, et al. Antimicrobial resistance in humans, livestock and the wider environment. Philosophical Transactions of the Royal Society of London B Biological Sciences 2015; 370: 20140083.
9. Singer, RS, Williams-Nguyen, J. Human health impacts of antibiotic use in agriculture: a push for improved causal inference. Current Opinion in Microbiology 2014; 19: 18.
10. KPMG LLP. The Global Economic Impact of Anti-microbial Resistance. KPMG LLP, 2014.
11. Taylor, J, et al. Estimating the Economic Costs of Antimicrobial Resistance: Model and Results. Santa Monica, CA: RAND Corporation, 2014.
12. Chandy, SJ, et al. High cost burden and health consequences of antibiotic resistance: the price to pay. Journal of Infection in Developing Countries 2014; 8: 10961102.
13. Ashiru-Oredope, D, Hopkins, S, English Surveillance Programme for Antimicrobial Utilization Resistance Oversight Group. Antimicrobial stewardship: English surveillance programme for antimicrobial utilization and resistance (ESPAUR). Journal of Antimicrobial Chemotherapy 2013; 68: 24212423.
14. Blair, JMA, et al. Molecular mechanisms of antibiotic resistance. Nature Reviews Microbiology 2015; 13: 4251.
15. Walsh, C. Molecular mechanisms that confer antibacterial drug resistance. Nature 2000; 406: 775781.
16. Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013. Atlanta: Centers for Disease Control and Prevention, 2013.
17. Laxminarayan, R, et al. Antibiotic resistance – the need for global solutions. The Lancet Infectious Diseases 2013; 13: 10571098.
18. Goossens, H, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005; 365: 579587.
19. Landers, TF, et al. A review of antibiotic use in food animals: perspective, policy, and potential. Public Health Reports 2012; 127: 422.
20. O'Niell, J. Antimicrobials in agriculture and the environment: reducing unncecessary use and waste. In: The Review on Antimicrobial Resistance. London: HM Government and the Wellcome Trust, 2015.
21. European Commission. Ban on antibiotics as growth promoters in animal feed enters into effect. 2005. (
22. Krishnasamy, V, Otte, J, Silbergeld, E. Antimicrobial use in Chinese swine and broiler poultry production. Antimicrobial Resistance & Infection Control 2015; 4: 17.
23. McEwen, SA, Fedorka-Cray, PJ. Antimicrobial use and resistance in animals. Clinical Infectious Diseases 2002; 34(Suppl. 3): S93S106.
24. Bell, BG, et al. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infectious Diseases 2014; 14: 13.
25. Finley, RL, et al. The scourge of antibiotic resistance: the important role of the environment. Clinical Infectious Diseases 2013; 57: 704710.
26. ECDC (European Centre for Disease Prevention and Control), E.E.F.S.A.a.E.E.M.A. ECDC/EFSA/EMA first joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals. EFSA Journal 2015; 13: 4006.
27. Mather, AE, et al. An ecological approach to assessing the epidemiology of antimicrobial resistance in animal and human populations. Proceedings of the Royal Society B: Biological Sciences 2012; 279: 16301639.
28. Price, LB, et al. Staphylococcus aureus CC398: host adaptation and emergence of methicillin resistance in livestock. mBio 2012; 3: e00305e00311.
29. Paterson, GK, et al. The newly described mecA homologue, mecALGA251, is present in methicillin-resistant Staphylococcus aureus isolates from a diverse range of host species. Journal of Antimicrobial Chemotherapy 2012; 67: 28092813.
30. Harrison, EM, et al. Whole genome sequencing identifies zoonotic transmission of MRSA isolates with the novel mecA homologue mecC. EMBO Molecular Medicine 2013; 5: 509515.
31. Datta, R, et al. Confounding by indication affects antimicrobial risk factors for methicillin-resistant Staphylococcus aureus but not vancomycin-resistant enterococci acquisition. Antimicrobial Resistance & Infection Control 2014; 3: 19.
32. Schechner, V, et al. Epidemiological interpretation of studies examining the effect of antibiotic usage on resistance. Clinical Microbiology Reviews 2013; 26: 289307.
33. Lowder, BV, et al. Recent human-to-poultry host jump, adaptation, and pandemic spread of Staphylococcus aureus. Proceedings of the National Academy of Sciences of the United States of America 2009; 106: 1954519550.
34. Voss, A, et al. Methicillin-resistant Staphylococcus aureus in pig farming. Emerging Infectious Diseases 2005; 11: 19651966.
35. Baptiste, KE, et al. Methicillin-resistant Staphylococci in companion animals. Emerging Infectious Diseases 2005; 11: 19421944.
36. Machado, E, et al. Antibiotic resistance integrons and extended-spectrum beta-lactamases among Enterobacteriaceae isolates recovered from chickens and swine in Portugal. Journal of Antimicrobial Chemotherapy 2008; 62: 296302.
37. Doi, Y, et al. Extended-spectrum and CMY-type beta-lactamase-producing Escherichia coli in clinical samples and retail meat from Pittsburgh, USA and Seville, Spain. Clinical Microbiology and Infection 2010; 16: 3338.
38. de Been, M, et al. Dissemination of cephalosporin resistance genes between Escherichia coli strains from farm animals and humans by specific plasmid lineages. PLoS Genetics 2014; 10: e1004776.
39. Mather, AE, et al. Distinguishable epidemics of multidrug-resistant Salmonella Typhimurium DT104 in different hosts. Science 2013; 341: 15141517.
40. Tacconelli, E, et al. STROBE-AMS: recommendations to optimise reporting of epidemiological studies on antimicrobial resistance and informing improvement in antimicrobial stewardship. BMJ Open 2016; 6: e010134.
41. Leopold, SJ, et al. Antimicrobial drug resistance among clinically relevant bacterial isolates in sub-Saharan Africa: a systematic review. Journal of Antimicrobial Chemotherapy 2014; 69: 23372353.
42. van Staa, T-P, et al. Pragmatic randomised trials using routine electronic health records: putting them to the test. British Medical Journal 2012; 344: e55.
43. Koser, CU, Ellington, MJ, Peacock, SJ. Whole-genome sequencing to control antimicrobial resistance. Trends in Genetics 2014; 30: 401407.
44. Lopardo, G, et al. Antimicrobial stewardship program in a developing country: the epidemiological barrier. Revista Panamericana de Salud Publica 2011; 30: 667668.
45. Aryee, A, Price, N. Antimicrobial stewardship – can we afford to do without it? British Journal of Clinical Pharmacology 2015; 79: 173181.
46. Bebell, LM, Muiru, AN. Antibiotic use and emerging resistance: how can resource-limited countries turn the tide? Global Heart 2014; 9: 347358.
47. Okeke, IN, et al. Diagnostics as essential tools for containing antibacterial resistance. Drug Resistance Updates 2011; 14: 95106.
48. World Health Organization. Country Pharmaceutical Situations. Geneva, Switzerland: World Health Organization, 2009.
49. Delepierre, A, Gayot, A, Carpentier, A. Update on counterfeit antibiotics worldwide; public health risks. Medecine et Maladies Infectieuses 2012; 42: 247255.
50. Kelesidis, T, et al. Counterfeit or substandard antimicrobial drugs: a review of the scientific evidence. Journal of Antimicrobial Chemotherapy 2007; 60: 214236.
51. Forrest, GN, et al. Use of Electronic health records and clinical decision support systems for antimicrobial stewardship. Clinical Infectious Diseases 2014; 59(Suppl. 3): S122S133.
52. Pires dos Santos, R, et al. Hand hygiene, and not ertapenem use, contributed to reduction of carbapenem-resistant Pseudomonas aeruginosa rates. Infection Control and Hospital Epidemiology 2011; 32: 584590.
53. Silver, LL. Challenges of antibacterial discovery. Clinical Microbiology Reviews 2011; 24(1): 71109.
54. Debono, M, et al. A21978C, a complex of new acidic peptide antibiotics: isolation, chemistry, and mass spectral structure elucidation. Journal of Antibiotics (Tokyo) 1987; 40: 761777.
55. O'Niell, J. Tackling drug-resistant infections globally: final report and recommendations. In: The Review on Antimicrobial Resistance. London: HM Government and the Wellcome Trust, 2016.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

A correction has been issued for this article: