Antibiotic Pollution in the Environment: From Microbial Ecology to Public Policy

Abstract

The ability to fight bacterial infections with antibiotics has been a longstanding cornerstone of modern medicine. However, wide-spread overuse and misuse of antibiotics has led to unintended consequences, which in turn require large-scale changes of policy for mitigation. In this review, we address two broad classes of corollaries of antibiotics overuse and misuse. Firstly, we discuss the spread of antibiotic resistance from hotspots of resistance evolution to the environment, with special concerns given to potential vectors of resistance transmission. Secondly, we outline the effects of antibiotic pollution independent of resistance evolution on natural microbial populations, as well as invertebrates and vertebrates. We close with an overview of current regional policies tasked with curbing the effects of antibiotics pollution and outline areas in which such policies are still under development.

Keywords: antibiotic pollution; antibiotic resistance; antimicrobial resistance (AMR) policies; environmental resistome.

Figure 1

Schematic flow of antibiotic resistance-carrying bacteria (ARBs) and antibiotic resistance genes (ARGs) from hotspots of evolution and transmission (red circles) to the environment (green circle). Blue circles indicate possible vectors that may aid transmission between specific environments including air, surface waters, humans, and other animal vectors. Black arrows indicate known flows of ARBs and ARGs, grey arrow indicates a possible transmission route from a contaminated environment back to the general populace.