Metals are overlooked in the evolution of antibiotic resistance

Metals are increasingly important risk factors for the evolution of antibiotic resistance in environments.

The rapid development of antibiotic resistance is occurring at a global scale. We therefore stride into the post-antibiotic era and have to battle antibiotic resistance in the Anthropocene. Metals are widely used and their pollution is widespread worldwide. More importantly, metal-induced co-selection greatly expands the environmental resistomes and increases the health risk of antibiotic resistance in environments. Here, we reviewed the metal-induced co-selection and their increasingly important roles in the development of antibiotic resistance. In particular, we highlight the metal-rich environments that maintain reservoirs for high-risk antibiotic resistance genes with horizontally transferable potentials. We also call for considerations and further investigations of other co-selective agents and the efficacy of metal-based interventions to better manage and combat the global antibiotic resistance crisis within the One Health framework.