Antibiotics, antibiotic-resistant bacteria, and genes in agri-foods: a global review of the consumption risks to human health

Antibiotics have reduced disease burdens in humans and animals, but the development of resistant microbes in agricultural products poses a risk. The long-term impacts of antibiotics in agri-foods remain poorly understood, making it difficult to assess their risks to human and animal health. Current research suggests that most antibiotic contamination in the agri-food chain poses negligible risks, based on assessments of measured environmental concentrations (MECs), predicted environmental concentration (PEC)/predicted no-effect concentration (PNEC) ratios (MEC/PNEC < 0.1), toxic units (TU = MECs/half-maximal effect concentration [EC50] < 0.01), and summed risk quotients (STUs < 0.3), but hotspots and unknowns need attention. To verify existing findings, we reviewed literature from Web of Science, Scopus, and ScienceDirect (n = 281,865), excluded duplicates (n = 272,085) and irrelevant studies (n = 9,516) based on predefined criteria (relevance, impact factor, citations), retaining 264 articles for analysis through a One Health approach. Although antimicrobial resistance (AMR) critically disrupts gut microbiota and increases global health/economic burdens, long-term studies frequently overlook key foodborne pathogens: Salmonella spp., Escherichia coli, Staphylococcus aureus, Listeria monocytogenes, Campylobacter, and Vibrio parahaemolyticus. This review provides new perspectives on the integration of AMR within a One Health concept by (1) summarizing current knowledge on the spread of antibiotic-resistant bacteria (ARB) and antibiotic-resistant genes (ARGs) in agri-food systems and their health and environmental human impacts and (2) identifying critical research gaps, particularly in understanding postingestion effects. A major finding of this review is that while there is documented transmission of antibiotic residues, ARBs, and ARGs to humans via the food chain, their actual impacts on gut-acquired infections remain largely unknown. Given the accelerating pace of AMR, delaying targeted research within the One Health framework is no longer an option. Immediate coordinated action across agriculture, policy, and science is critical to close these knowledge gaps, disrupt resistance pathways, and safeguard the health of humans, animals, and ecosystems before AMR escalates beyond control.