Global antibiotic resistance: of contagion, confounders, and the COM-B model

Antibiotic resistance is an inevitable consequence of selective pressure imposed by antibiotic use in human beings, (food) animals, agriculture, and aquaculture. It generally results from overuse and indiscriminate use of antibiotics in developed countries and underuse and misuse of them in developing countries. When a bacterial population is exposed to an antibiotic, susceptible organisms are eradicated whereas resistant ones persist and pass on their resistant genes to their offspring by replication (vertical transfer) or to other species through conjugation, transformation, and transduction (horizontal gene transfer) via mobile genetic elements such as plasmids, transposons, and integrons.