A 15-Year One Health Approach to Antimicrobial Resistance in Kuwait from Hospitals to Environmental Contexts: A...

Kuwait has reported a problematic increase in the prevalence of Antimicrobial Resistance (AMR). However, the absence of studies that analyze AMR from combined human, agricultural (animal), and environmental domains limits our ability to assess the extent of the problem in Kuwait. Therefore, this systematic review provides a comprehensive insight into the AMR status in Kuwait regarding humans, agriculture (animals), and the environment from the perspective of the One Health approach. A systematic search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify the relevant literature on AMR in Kuwait. Multiple online electronic databases, including the Cochrane Library, Google Scholar, Web of Science, PubMed, BioMed Central (BMC), and Scopus, were searched to perform a narrative synthesis and meta-analysis. Twenty-eight studies published between 2009 and 2024 were included in this study. Domain-wise distribution varied, with 11 studies related to clinical settings, 11 to the environment, 4 to agricultural (animal), and 2 to both clinical and community settings. The narrative synthesis indicated a high occurrence of AMR bacteria in human, agriculture (animal), and environmental domains. In human domains, the dominant AMR isolates belonged to four Gram-negative species: E. coli, K. pneumoniae, P. aeruginosa, and Acinetobacter baumannii. In agriculture (animals), Salmonella isolates from poultry display high resistance to cefotaxime, ampicillin, and amoxicillin. Camel milk analyses revealed that 80% of bacterial isolates are resistant to antibiotics such as penicillin, tetracyclines, and carbapenems. An environmental analysis of sewage, seawater, sediment, and aerosol samples documented widespread antibiotic resistance genes (ARGs) with resistance mechanisms such as extended-spectrum beta-lactamase, carbapenemases, and colistin. The cross-domain analysis identified the overlapping of ARGs. Regarding the One Health approach, none of the studies used this approach to interlink these sectors. Meanwhile, the meta-analysis indicated a high resistance rate in humans (34.05%, 95% CI (22.81 to 46.27, p < 0.0001, I² = 98.94%)), agriculture (animals) (67.42%, 95% CI (30.30 to 94.93, p < 0.0001, I² = 97.40%)), and environment (69.86%, 95% CI (48.80 to 87.26, p < 0.0001, I² = 98.78%)). The reported spread of AMR and the overlap of resistance genes among isolates across the domains demonstrate the interconnected nature of AMR in Kuwait. These findings underscore the need to adopt the One Health approach to strengthen surveillance, implement control measures, and enhance public education strategies to address the complexity of AMR challenges in Kuwait.