Antibiotic-resistance gene dissemination in aquatic ecosystems: from rivers through food chain to clinical spill-over

Antimicrobial resistance (AMR) increasingly emerges from the coupled selection and transmission dynamics across wastewater, surface waters, food production, and human exposure networks. Evidence from 2016 to 2025 highlights that these processes are accelerated by climate stressors, unregulated industrial waste, and integrated food-production loops. Within the “One Health” framework, aquatic environments serve as global reservoirs bridging agricultural runoff and clinical settings. Specifically, rivers, estuaries, and coastal zones act as convergence hubs where antibiotic residues and co-selectors (e.g., metals and biocides) facilitate the persistence of resistant bacteria and mobile genetic elements (MGEs). While sediments and biofilms provide long-term reservoirs for horizontal gene transfer, downstream activities—such as irrigation, aquaculture, and drinking water distribution—create high-frequency interfaces for human exposure. Although quantitative risk assessment is shifting toward colonisation and treatability endpoints, effective mitigation remains dependent on integrated source control and mobility-aware surveillance.