Antibiotic resistance in the absence of antimicrobial use: mechanisms and implications

The selective pressure generated by the use of antibiotics in clinical, veterinary, husbandry and agricultural practices is considered the major factor responsible for the emergence and spread of antibiotic-resistant bacteria since the beginning of the antibiotic era. However, recent studies have consistently demonstrated that acquired resistance traits can also be found in bacteria isolated from humans and wild animals not subjected to significant antibiotic exposure and living in remote areas of the planet. The scope of this article is to review and discuss the current knowledge on this intriguing phenomenon, which underscores the complexity of the mechanisms involved in the emergence and spread of antibiotic resistance and bears some relevant implications to the design and success of resistance-control strategies.