Systematic Review and Meta-Analysis of Antimicrobial Susceptibility among Aeromonas spp. from a One Health perspective

Daniel Christopher Jones, Lou LaMartina, Jenna Lewis, Andrew James Dahl, Nischala Nagesh Holavanahalli, Ryan Newton, Troy A Skwor

International Journal of Antimicrobial Agents • 16 May 2023 • https://doi.org/10.1016/j.ijantimicag.2023.106848

As antimicrobial resistance (AMR) remains one of the most pressing public health concerns, it is imperative to advance our understanding of the factors influencing it from Global and One Health approaches. To address this concern, we identified Aeromonas populations using 16S rRNA gene libraries among human, agriculture, aquaculture, drinking water, surface water, and wastewater samples, supporting its use as indicator bacteria to study AMR. We then performed a systematic review and meta-analysis from Global and One Health perspectives including data from 221 articles describing 15,891 isolates obtained from 57 countries. The interconnectedness of various environments was evident after identifying minimal differences between sectors among 21 different antimicrobials. However, resistance to critically important antibiotics (aztreonam and cefepime) was significantly higher among wastewater populations compared to clinical isolates. Additionally, isolates from untreated wastewater typically exhibited increased AMR compared to those from treated wastewater. Furthermore, aquaculture was associated with increased AMR to ciprofloxacin and tetracycline compared to wild-caught seafood. Using the World Health Organization's AWaRe classifications, countries with lower consumption of “Access” compared to “Watch” drugs from 2000 to 2015 demonstrated higher AMR levels. Our analysis revealed negative correlations between AMR and anthropogenic factors, like environmental performance indices and socioeconomic standing. Environmental health and sanitation were some of the strongest environmental factors correlated with AMR. Together, our analysis highlights the negative impacts of “Watch” drug overconsumption, anthropogenic activity, absence of wastewater infrastructure, and aquaculture on AMR, thus stressing the need for proper infrastructure and global regulations to combat this growing problem.