Antimicrobial Resistance at the Human-Animal-Environment Interface: A One Health Perspective on Drivers, Transmission, and Public Health Responses.

BACKGROUND: Antimicrobial resistance (AMR) is a global health threat driven by interconnected antimicrobial use and environmental pressures across human, animal, and ecological systems. This review synthesizes current evidence on the major drivers, transmission pathways, reservoirs, surveillance challenges, and public health responses associated with AMR at the human-animal-environment interface. METHODS: Relevant literature published up to March 2026 was identified through searches of PubMed, Scopus, Web of Science, and Google Scholar using terms related to AMR, One Health, antimicrobial use, transmission, surveillance, and public health responses. Peer-reviewed studies, systematic reviews, and reliable reports were considered, while duplicate, unrelated, non-English, and non-peer-reviewed publications were excluded. RESULTS: AMR is driven by inappropriate antimicrobial use in human healthcare, livestock and aquaculture production, and environmental contamination from wastewater, agricultural runoff, and pharmaceutical discharges. Resistant organisms and antimicrobial resistance genes circulate across sectors through food, water, direct contact, occupational exposure, wildlife, and horizontal gene transfer. Major gaps remain in integrated surveillance, cross-sector data sharing, diagnostic capacity, laboratory infrastructure, and implementation, particularly in resource-limited settings. These challenges are compounded by fragmented governance, inadequate regulation, limited stewardship, and poor coordination among human, animal, and environmental health sectors, hindering effective AMR prevention and control. CONCLUSIONS: Containing AMR requires coordinated One Health action integrating antimicrobial stewardship, infection prevention, improved diagnostics, harmonized surveillance, environmental monitoring, and cross-sector data sharing. Strengthening implementation capacity and equitable collaboration is essential for effective and sustainable AMR control.