Probiotic-Fermented Foods and Antimicrobial Stewardship: Mechanisms, Evidence, and Translational Pathways Against AMR

Antimicrobial resistance (AMR) remains a critical global challenge, requiring novel complementary strategies beyond antibiotic development. Probiotic-fermented foods (PFFs) offer an emerging, low-cost approach to mitigate AMR risk through ecological, molecular, and immunological mechanisms. This review integrates mechanistic insights, clinical evidence, and translational frameworks linking PFFs to antimicrobial stewardship. Key mechanisms include colonization resistance, nutrient and adhesion-site competition, production of antimicrobial metabolites, such as bacteriocins, hydrogen peroxide, and organic acids and Quorum-quenching-sensing activities that suppress pathogen virulence. Randomized clinical trials indicate that fermented diets and probiotic supplementation can improve microbiome diversity, reduce inflammatory cytokines, and decrease antibiotic-associated diarrhea, though direct AMR outcomes remain underexplored. Evidence from kefir, kombucha, and other microbial consortia suggests potential for in vivo pathogen suppression and reduced infection duration. However, safe translation requires standardized starter-culture genomics, resistome monitoring, and regulatory oversight under QPS/GRAS frameworks. Integrating PFF research with One Health surveillance systems, such as the WHO GLASS platform, will enable tracking of antimicrobial consumption and resistance outcomes. Collectively, these findings position PFFs as promising adjuncts for AMR mitigation, linking sustainable food biotechnology with microbiome-based health and global stewardship policies.