Impacts of mobile genetic elements on antimicrobial resistance genes in gram-negative pathogens: Current insights and...

Antimicrobial resistance threatens to take 10 million lives per year by 2050. It is a recognised global health crisis and understanding the historic and current spread of resistance determinants is important for informing surveillance and control measures. The 'inheritance' of resistance is difficult to track because horizontal transfer is common. Antimicrobial resistance genes (ARGs) spread rapidly between bacteria, plasmids and chromosomes due to different mobile genetic elements (MGEs). This movement can increase the range of species carrying an ARG, simplify acquisition of multi-resistance, or otherwise alter the selective advantage associated with carriage of the ARG. MGE activity is therefore a significant factor in understanding routes of ARG dissemination. Characterising the combinations of MGEs contributing to the movement of individual ARGs is crucial. Each MGE category has unique genetic characteristics, and distinct impacts on the location and expression of associated ARGs. Here, the ways in which MGEs can meaningfully associate with ARGs are discussed. Approaches for extracting information about MGE associations from bacterial genome sequences are also considered. Accurate and informative annotations of the genetic contexts of relevant ARGs provide crucial insight into the presence of MGEs and their locations relative to ARGs. Combining this genomic information with knowledge about relevant biological processes allows more accurate conclusions to be drawn about transmission and dissemination of ARGs.