Impacts of antimicrobial resistance: examining the animal and human health, economic and environmental consequences

This article examines current options and data availability for estimating impact of antimicrobial resistance (AMR) from a One Health perspective. Microbes resistant to antimicrobials are transmitted among all One Health compartments, but the weights of the different transmission routes are under-studied. The environment serves as a reservoir and vehicle for transmission of resistant bacteria, and antimicrobial pollution can contribute to evolution of AMR. Therapeutic failures are well known to impact AMR in the livestock sector but are seldom translated into economic metrics. Detailed and harmonised global data on antimicrobial use and resistance is lacking, and there is no universally recognised system for estimating costs for animal morbidity and mortality, production loss and health expenditure. Estimates of the impact of AMR in the human health sector have better geographical coverage and are more detailed than in the livestock sector. Still, there is a scarcity of data from some parts of the world. Impacts in this sector include a substantial burden on healthcare systems due to slower recovery and increased risk of complications from infectious diseases. For both the livestock sector and the human health sector, impact and mitigation opportunities for AMR as well as data availability differ between economic settings, with more severe consequences and fewer mitigation opportunities in low- and middle-income countries than in high-income countries. The economic impact on the livestock sector in particular remains under-reported. Calculating such costs may motivate farmers to adopt a more restrictive and medically rational use of antimicrobials and mitigate the potential for divergence between the livestock sector perspective and public health perspective on antimicrobial use.