Fig. 2

Potential routes of transmission of antibiotic-resistant bacteria. Legend: Humans in the community or in hospitals, pets, livestock and fish farms rely on similar classes of antibiotics to fight infectious diseases. Both pathogenic and non-pathogenic bacteria evolve or exchange the ability to survive when exposed to these antibiotics. They spread into the environment through different routes, such as water sanitation systems (1), as wastewater treatment facilities do not entirely remove antibiotic resistant bacteria before releasing water into the environment. Another common route is through the application of manure to fields with cultivated crops (2), where antibiotic resistant bacteria can readily develop on the plants (3). The uptake of these resistant bacteria can then happen through the food chain, when humans later consume these plants (4) or the contaminated flesh of animals and fish harbouring resistant bacteria (5). As bacteria can easily reach water reserves, water distribution infrastructure is also a potential route for the spread of these germs (6). Even wildlife, insects and other bugs are potential carriers of antimicrobial resistance (7). Tourism, migrations and food imports (8) are nevertheless reported as the fastest way of spreading resistant strains of bacteria across borders. At the healthcare facilities level, resistant bacteria can spread by contact between patients or with healthcare staff, or through contaminated surfaces and medical devices. Reproduced with permission from bioMérieux (modified)