Food-Associated Stressors and Their Synergistic Roles in Bacterial Antibiotic Resistance across the Food Supply Chain

This is the authors' abstract. We don't add key points for this paper.

Global bacterial antibiotic resistance threatens health, food safety, and sustainability. The food supply chain is a critical "One Health" pathway, linking agriculture, environment, and processing. However, systematic reviews addressing the impact of coexisting stressors on antibiotic resistance emergence and transmission across this continuum are lacking. This review innovatively synthesizes environmental inputs (antibiotic residues, fertilizers, heavy metals, pesticides, microplastics, climate change, and grazing) and processing/transport stressors (temperature, nonthermal technologies, pH, osmosis, disinfectants, food additives, probiotics, and trade), focusing on their individual and synergistic effects. These stressors enhance resistance and horizontal gene transfer by activating bacterial stress responses (sigma factors, SOS), altering membranes, and triggering mutations/efflux pumps. Coexisting stressors can further intensify, accelerate, and amplify resistance emergence and transmission. We propose multilevel mitigation strategies across the food chain, including curbing selective pressures at the source, optimizing food processing techniques to avoid stress-induced resistance, guiding consumer behavior, and strengthening international regulatory governance.