Climate change and antimicrobial resistance: a global public health crisis at the environmental nexus
Abstract
Antimicrobial resistance (AMR) and climate change are major global public health challenges, with growing evidence indicating interconnected relationships. This review explores the multifaceted links between climate change and AMR, focusing on how rising temperatures influence bacterial resistance mechanisms, alter pathogen distribution patterns, and affect environmental reservoirs of resistance genes. Evidence synthesized in this review indicates that rising temperatures correlate with increased AMR rates across multiple regions, with each 1°C temperature increase linked to higher resistance prevalence. Climate change affects environmental transmission dynamics via soil ecosystems, aquatic environments, and cryosphere degradation, which can release long-dormant resistance determinants from permafrost and glaciers. Rising temperatures facilitate the geographic spread of resistant pathogens, as observed in Vibrio species expanding to higher latitudes and the emergence of Candida auris as a clinically significant pathogen from environmental sources. Wildlife and livestock act as potential reservoirs, while climate-driven habitat changes increase human-animal interactions that may facilitate transmission. The bidirectional relationship between these challenges—where rising temperatures contribute to AMR spread and resistant infections may hinder climate resilience—requires integrated One Health approaches. Strategies proposed include enhanced surveillance, climate-informed antimicrobial stewardship, and ecosystem-based interventions to address these interconnected issues. Importantly, integrating climate-informed health policies that align climate adaptation with AMR control should be prioritized globally to safeguard antimicrobial efficacy amid accelerating environmental changes.
References
Fady P-E, Richardson A, Barron L, Volpe R, Mason AJ, Barr M. Biochar filtration of drug-resistant bacteria and active pharmaceutical ingredients to combat antimicrobial resistance. In Review; 2024. https://doi.org/10.21203/rs.3.rs-5205128/v1
Li Z, Sun A, Liu X, Chen Q-L, Bi L, Ren P-X, et al. Climate warming increases the proportions of specific antibiotic resistance genes in natural soil ecosystems. Journal of Hazardous Materials. 2022;430: 128442. https://doi.org/10.1016/j.jhazmat.2022.128442
Cruz-Loya M, Tekin E, Kang TM, Cardona N, Lozano-Huntelman N, Rodriguez-Verdugo A, et al. Antibiotics Shift the Temperature Response Curve of Escherichia coli Growth. Stegen JC, editor. mSystems. 2021;6: 10.1128/msystems.00228-21. https://doi.org/10.1128/msystems.00228-21
Mira P, Lozano-Huntelman N, Johnson A, Savage VM, Yeh P. Evolution of antibiotic resistance impacts optimal temperature and growth rate in Escherichia coli and Staphylococcus epidermidis. Journal of Applied Microbiology. 2022;133: 2655-2667. https://doi.org/10.1111/jam.15736
Schmidt K, Scholz HC, Appelt S, Michel J, Jacob D, Dupke S. Virulence and resistance patterns of Vibrio cholerae non-O1/non-O139 acquired in Germany and other European countries. Front Microbiol. 2023;14: 1282135. https://doi.org/10.3389/fmicb.2023.1282135
Arora P, Singh P, Wang Y, Yadav A, Pawar K, Singh A, et al. Environmental Isolation of Candida auris from the Coastal Wetlands of Andaman Islands, India. Cowen LE, editor. mBio. 2021;12: e03181-20. https://doi.org/10.1128/mBio.03181-20
Huang J, Hu P, Ye L, Shen Z, Chen X, Liu F, et al. Pan-drug resistance and hypervirulence in a human fungal pathogen are enabled by mutagenesis induced by mammalian body temperature. Nat Microbiol. 2024;9: 1686-1699. https://doi.org/10.1038/s41564-024-01720-y
Song JH, Kong HG. Effects of Temperature on Resistance to Streptomycin in Xanthomonas arboricola pv. pruni. Plant Pathol J. 2025;41: 78-87. https://doi.org/10.5423/PPJ.OA.08.2024.0119
McGough SF, MacFadden DR, Hattab MW, Mølbak K, Santillana M. Rates of increase of antibiotic resistance and ambient temperature in Europe: a cross-national analysis of 28 countries between 2000 and 2016. Eurosurveillance. 2020;25. https://doi.org/10.2807/1560-7917.ES.2020.25.45.1900414
Li W, Liu C, Ho HC, Shi L, Zeng Y, Yang X, et al. Association between antibiotic resistance and increasing ambient temperature in China: an ecological study with nationwide panel data. The Lancet Regional Health - Western Pacific. 2023;30: 100628. https://doi.org/10.1016/j.lanwpc.2022.100628
Zeng Y, Li W, Zhao M, Li J, Liu X, Shi L, et al. The association between ambient temperature and antimicrobial resistance of Klebsiella pneumoniae in China: a difference-in-differences analysis. Front Public Health. 2023;11: 1158762. https://doi.org/10.3389/fpubh.2023.1158762
Feldman SF, Temkin E, Wulffhart L, Nutman A, Schechner V, Shitrit P, et al. Effect of temperature on Escherichia coli bloodstream infection in a nationwide population-based study of incidence and resistance. Antimicrob Resist Infect Control. 2022;11: 144. https://doi.org/10.1186/s13756-022-01184-x
Li W, Liu C, Ho HC, Shi L, Zeng Y, Yang X, et al. Estimating the effect of increasing ambient temperature on antimicrobial resistance in China: A nationwide ecological study with the difference-in-differences approach. Science of The Total Environment. 2023;882: 163518. https://doi.org/10.1016/j.scitotenv.2023.163518
Alqahtani MSM, Shahin G, Abdelalim ITI, Khalaf SMH. Evaluation of ecological consequences on the global distribution of Staphylococcus aureus Rosenbach 1884 due to climate change, using Maxent modeling. Sci Rep. 2025;15: 11457. https://doi.org/10.1038/s41598-025-87534-2
Kaba HEJ, Kuhlmann E, Scheithauer S. Thinking outside the box: Association of antimicrobial resistance with climate warming in Europe - A 30 country observational study. International Journal of Hygiene and Environmental Health. 2020;223: 151-158. https://doi.org/10.1016/j.ijheh.2019.09.008
Qiu L, Wang Y, Du W, Ai F, Yin Y, Guo H. Efflux pumps activation caused by mercury contamination prompts antibiotic resistance and pathogen's virulence under ambient and elevated CO2 concentration. Science of The Total Environment. 2023;863: 160831. https://doi.org/10.1016/j.scitotenv.2022.160831
Zhang Y, Li H-Z, Breed M, Tang Z, Cui L, Zhu Y-G, et al. Soil warming increases the active antibiotic resistome in the gut of invasive giant African snails. Microbiome. 2025;13: 42. https://doi.org/10.1186/s40168-025-02044-7
Wang Y-N, Cai T-G, Li Y, Dai W-C, Lin D, Zheng J-T, et al. Warming exacerbates the effects of pesticides on the soil collembolan gut microbiome and antibiotic resistome. Journal of Hazardous Materials. 2025;492: 138294. https://doi.org/10.1016/j.jhazmat.2025.138294
Xu M, Xiang Q, Xu F, Guo L, Carter LJ, Du W, et al. Elevated CO2 alleviated the dissemination of antibiotic resistance genes in sulfadiazine-contaminated soil: A free-air CO2 enrichment study. Journal of Hazardous Materials. 2023;450: 131079. https://doi.org/10.1016/j.jhazmat.2023.131079
Bagra K, Kneis D, Padfield D, Szekeres E, Teban-Man A, Coman C, et al. Contrary effects of increasing temperatures on the spread of antimicrobial resistance in river biofilms. McMahon K, editor. mSphere. 2024;9: e00573-23. https://doi.org/10.1128/msphere.00573-23
Barbieri M, Barberio MD, Banzato F, Billi A, Boschetti T, Franchini S, et al. Climate change and its effect on groundwater quality. Environ Geochem Health. 2023;45: 1133-1144. https://doi.org/10.1007/s10653-021-01140-5
Lee S, Suits M, Wituszynski D, Winston R, Martin J, Lee J. Residential urban stormwater runoff: A comprehensive profile of microbiome and antibiotic resistance. Science of The Total Environment. 2020;723: 138033. https://doi.org/10.1016/j.scitotenv.2020.138033
Stankiewicz K, Boroń P, Prajsnar J, Lenart-Boroń A. Is our winter experience safe? Micropollutant risks for artificial snowing. Science of The Total Environment. 2025;968: 178876. https://doi.org/10.1016/j.scitotenv.2025.178876
Chen Y, Yan Z, Su P, Liu S, Chen X, Jiang R, et al. Remediation strategy of biochar with different addition approaches on antibiotic resistance genes in riparian zones under dry wet alternation. Journal of Hazardous Materials. 2025;492: 138207. https://doi.org/10.1016/j.jhazmat.2025.138207
Zheng Z, Ye L, Xu Y, Chan EW, Chen S. Dynamics of antimicrobial resistance and genomic characteristics of foodborne Vibrio spp. in Southern China (2013-2022). Journal of Hazardous Materials. 2024;479: 135672. https://doi.org/10.1016/j.jhazmat.2024.135672
Xu N, Qiu D, Zhang Z, Wang Y, Chen B, Zhang Q, et al. A global atlas of marine antibiotic resistance genes and their expression. Water Research. 2023;244: 120488. https://doi.org/10.1016/j.watres.2023.120488
Zin H, Lim J, Shin Y, Kim B, Yoon M, Ha K, et al. Genomic Insights into Vibrio parahaemolyticus from Southern Korea: Pathogenicity, Antimicrobial Resistance, and Phylogenetic Distinctions. Microorganisms. 2024;12: 2497. https://doi.org/10.3390/microorganisms12122497
Di Cesare A, Sathicq MB, Sbaffi T, Sabatino R, Manca D, Breider F, et al. Parity in bacterial communities and resistomes: Microplastic and natural organic particles in the Tyrrhenian Sea. Marine Pollution Bulletin. 2024;203: 116495. https://doi.org/10.1016/j.marpolbul.2024.116495
Brumfield KD, Usmani M, Santiago S, Singh K, Gangwar M, Hasan NA, et al. Genomic diversity of Vibrio spp. and metagenomic analysis of pathogens in Florida Gulf coastal waters following Hurricane Ian. Vidaver AK, editor. mBio. 2023;14: e01476-23. https://doi.org/10.1128/mbio.01476-23
Yibar A, Ay H, Aydin F, Abay S, Karakaya E, Kayman T, et al. Integrated assessment of mucilage impact on human health using the One Health approach: Prevalence and antimicrobial resistance profiles of Escherichia coli and Clostridium perfringens in the Marmara Sea, Türkiye. Heliyon. 2025;11: e42103. https://doi.org/10.1016/j.heliyon.2025.e42103
EFSA Panel on Biological Hazards (BIOHAZ), Koutsoumanis K, Allende A, Alvarez‐Ordóñez A, Bolton D, Bover‐Cid S, et al. Public health aspects of Vibrio spp. related to the consumption of seafood in the EU. EFS2. 2024;22. https://doi.org/10.2903/j.efsa.2024.8896
Kim H, Kim M, Kim S, Lee YM, Shin SC. Characterization of antimicrobial resistance genes and virulence factor genes in an Arctic permafrost region revealed by metagenomics. Environmental Pollution. 2022;294: 118634. https://doi.org/10.1016/j.envpol.2021.118634
Rakitin AL, Ermakova AY, Beletsky AV, Petrova M, Mardanov AV, Ravin NV. Genome Analysis of Acinetobacter lwoffii Strains Isolated from Permafrost Soils Aged from 15 Thousand to 1.8 Million Years Revealed Their Close Relationships with Present-Day Environmental and Clinical Isolates. Biology. 2021;10: 871. https://doi.org/10.3390/biology10090871
Mogrovejo‐Arias DC, Hay MC, Edwards A, Mitchell AC, Steinmann J, Brill FHH, et al. Investigating the resistome of haemolytic bacteria in Arctic soils. Environ Microbiol Rep. 2024;16: e70028. https://doi.org/10.1111/1758-2229.70028
Mao G, Ji M, Jiao N, Su J, Zhang Z, Liu K, et al. Monsoon affects the distribution of antibiotic resistome in Tibetan glaciers. Environmental Pollution. 2023;317: 120809. https://doi.org/10.1016/j.envpol.2022.120809
Ren Z, Gao H. Antibiotic resistance genes in integrated surface ice, cryoconite, and glacier-fed stream in a mountain glacier in Central Asia. Environment International. 2024;184: 108482. https://doi.org/10.1016/j.envint.2024.108482
Ren Z, Luo W. Metagenomic analysis reveals the diversity and distribution of antibiotic resistance genes in thermokarst lakes of the Yellow River Source Area. Environmental Pollution. 2022;313: 120102. https://doi.org/10.1016/j.envpol.2022.120102
Rigou S, Christo-Foroux E, Santini S, Goncharov A, Strauss J, Grosse G, et al. Metagenomic survey of the microbiome of ancient Siberian permafrost and modern Kamchatkan cryosols. microLife. 2022;3: uqac003. https://doi.org/10.1093/femsml/uqac003
Di Bartolomeo F, Ligresti R, Pettenuzzo S, Bini T, Tincati C, Marchetti GC. Shewanella putrefaciens, an emerging foe from climate change: a case report. J Med Case Reports. 2025;19: 105. https://doi.org/10.1186/s13256-025-05100-w
Gray HK, Bisht A, Caldera J, Fossas Braegger NM, Cambou MC, Sakona AN, et al. Nosocomial infections by diverse carbapenemase-producing Aeromonas hydrophila associated with combination of plumbing issues and heat waves. American Journal of Infection Control. 2024;52: 337-343. https://doi.org/10.1016/j.ajic.2023.09.013
Erkorkmaz BA, Zeevi D, Rudich Y. Dust storm-driven dispersal of potential pathogens and antibiotic resistance genes in the Eastern Mediterranean. Science of The Total Environment. 2025;958: 178021. https://doi.org/10.1016/j.scitotenv.2024.178021
Martín-Maldonado B, Vega S, Mencía-Gutiérrez A, Lorenzo-Rebenaque L, De Frutos C, González F, et al. Urban birds: An important source of antimicrobial resistant Salmonella strains in Central Spain. Comparative Immunology, Microbiology and Infectious Diseases. 2020;72: 101519. https://doi.org/10.1016/j.cimid.2020.101519
Meng X, Chen F, Xiong M, Hao H, Wang K-J. A new pathogenic isolate of Kocuria kristinae identified for the first time in the marine fish Larimichthys crocea. Front Microbiol. 2023;14: 1129568. https://doi.org/10.3389/fmicb.2023.1129568
Casalino G, D'Amico F, Dinardo FR, Bozzo G, Napoletano V, Camarda A, et al. Prevalence and Antimicrobial Resistance of Campylobacter jejuni and Campylobacter coli in Wild Birds from a Wildlife Rescue Centre. Animals. 2022;12: 2889. https://doi.org/10.3390/ani12202889
Sauermann CW, Leathwick DM, Lieffering M, Nielsen MK. Climate change is likely to increase the development rate of anthelmintic resistance in equine cyathostomins in New Zealand. International Journal for Parasitology: Drugs and Drug Resistance. 2020;14: 73-79. https://doi.org/10.1016/j.ijpddr.2020.09.001
Akarsu H, Liljander A, Younan M, Brodard I, Overesch G, Glücks I, et al. Genomic Characterization and Antimicrobial Susceptibility of Dromedary-Associated Staphylococcaceae from the Horn of Africa. Elkins CA, editor. Appl Environ Microbiol. 2022;88: e01146-22. https://doi.org/10.1128/aem.01146-22
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