One Health, no silos: integrating veterinary, human, and environmental stewardship strategies to close the AMR diagnostic gap in the United States

Antimicrobial resistance (AMR) is a growing global crisis that threatens the health of humans, animals, and the environment. It has been projected that if not urgently and judiciously addressed, there could be up to 10 million deaths each year by 2050 caused by AMR infections. AMR is not a static or easily eradicated issue tied to a singular source; it emerges from intersecting pressures across human, animal, and environmental health and is exacerbated by the misuse and potential excessive use of antimicrobials. This review highlights the importance of an integrated, One-Health approach in tackling AMR, underscoring the need for a coordinated antimicrobial stewardship process that centers on optimal diagnostic approaches spanning all sectors. Significant gaps in diagnostics persist between human and veterinary medicine, especially with regard to diagnostic capacity, antimicrobial susceptibility testing, and standardized reporting. In environmental settings, additional challenges include suboptimal effluent and waste management, continued reliance on antimicrobials for non-therapeutic purposes, and inconsistent soil and water management practices. Taken together, these issues hinder the ability to manage AMR, while the siloed nature of these three primary sectors complicates data integration and ultimately weakens global surveillance and mitigation efforts. To improve One Health antimicrobial stewardship strategies, we must strengthen diagnostic capacity, harmonize antimicrobial susceptibility testing (AST) methods across human and veterinary health, and integrate surveillance systems to include environmental sources worldwide. Further development and investment in rapid diagnostics, standardized protocols, and collaborative data-sharing frameworks is crucial in addressing local and global AMR to ensure the effectiveness of antimicrobials for future generations.