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<p>Antimicrobial resistance (AMR) is a paramount global health threat. While antibiotic misuse is a recognized driver, other environmental pollutants, particularly non-biodegradable heavy metals, are increasingly implicated in the selection and dissemination of resistance through co-selection mechanisms. This systematic review synthesizes evidence on the role of environmental heavy metal contamination as a driver of AMR evolution and spread. A systematic search was conducted across seven databases (PubMed, Web of Science, Scopus, Cochrane, Biomed Central, Google Scholar, and Embase) between November 2023&#xa0;and January 2024, following PRISMA guidelines. Studies investigating the impact of heavy metals on AMR in environmental matrices were included. Study quality was assessed using the CASP checklist, and data were synthesized thematically. From 9513 records, 22 studies published between 2018 and 2024 were included. Evidence frequently reported strong associations between heavy metal pollution (e.g., Pb, Cd, Hg) and increased abundance and diversity of antibiotic resistance genes (ARGs) in wastewater, riverine, and soil ecosystems. The dominant mechanism identified in the reviewed studies was co-resistance, with metal resistance genes and ARGs co-located on mobile genetic elements, facilitating horizontal transfer. Cross-resistance and co-regulation were also reported. Importantly, metal pollution was linked to the environmental presence of high-risk multidrug-resistant pathogens. Methodological appraisal revealed a predominance of cross-sectional studies and limited data on metal speciation, constraining causal inference. The reviewed evidence suggests that environmental heavy metal pollution may be an important but underappreciated driver of AMR, potentially acting through co-selection. Effective AMR control requires integrated strategies combining antimicrobial stewardship with environmental governance. Future studies should adopt longitudinal designs and advanced molecular tools to establish causation and quantify risks.</p> Graphical abstract <p>Environmental heavy metal pollution from industry and agriculture releases persistent toxins like lead and mercury into ecosystems. This pressure selects for bacteria carrying metal and antibiotic resistance traits that may be linked through multiple mechanisms including co-resistance (genes on shared mobile elements). These resistant traits can spread between microbes via horizontal gene transfer in contaminated water and soil. Ultimately, this process may contribute to the emergence of multidrug-resistant pathogens, threatening to compromise antibiotic efficacy and human health on a global scale</p> <p></p>

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Do potentially toxic elements drive antimicrobial resistance? A systematic review of co-selection mechanisms and environmental reservoirs

  • 期刊论文

  • 发表日期：

    2026年5月11日

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  • Caroline Nakirijja,
  • Benjamine Oritsemuelebi,
  • Danladi Chiroma Husaini,
  • Chukwuemeka R. Nwokocha,
  • Polycarp Dauda Madaki,
  • Chiara Frazzoli,
  • Orish Ebere Orisakwe

摘要

Antimicrobial resistance (AMR) is a paramount global health threat. While antibiotic misuse is a recognized driver, other environmental pollutants, particularly non-biodegradable heavy metals, are increasingly implicated in the selection and dissemination of resistance through co-selection mechanisms. This systematic review synthesizes evidence on the role of environmental heavy metal contamination as a driver of AMR evolution and spread. A systematic search was conducted across seven databases (PubMed, Web of Science, Scopus, Cochrane, Biomed Central, Google Scholar, and Embase) between November 2023 and January 2024, following PRISMA guidelines. Studies investigating the impact of heavy metals on AMR in environmental matrices were included. Study quality was assessed using the CASP checklist, and data were synthesized thematically. From 9513 records, 22 studies published between 2018 and 2024 were included. Evidence frequently reported strong associations between heavy metal pollution (e.g., Pb, Cd, Hg) and increased abundance and diversity of antibiotic resistance genes (ARGs) in wastewater, riverine, and soil ecosystems. The dominant mechanism identified in the reviewed studies was co-resistance, with metal resistance genes and ARGs co-located on mobile genetic elements, facilitating horizontal transfer. Cross-resistance and co-regulation were also reported. Importantly, metal pollution was linked to the environmental presence of high-risk multidrug-resistant pathogens. Methodological appraisal revealed a predominance of cross-sectional studies and limited data on metal speciation, constraining causal inference. The reviewed evidence suggests that environmental heavy metal pollution may be an important but underappreciated driver of AMR, potentially acting through co-selection. Effective AMR control requires integrated strategies combining antimicrobial stewardship with environmental governance. Future studies should adopt longitudinal designs and advanced molecular tools to establish causation and quantify risks.

Graphical abstract

Environmental heavy metal pollution from industry and agriculture releases persistent toxins like lead and mercury into ecosystems. This pressure selects for bacteria carrying metal and antibiotic resistance traits that may be linked through multiple mechanisms including co-resistance (genes on shared mobile elements). These resistant traits can spread between microbes via horizontal gene transfer in contaminated water and soil. Ultimately, this process may contribute to the emergence of multidrug-resistant pathogens, threatening to compromise antibiotic efficacy and human health on a global scale