Evidence for the circulation of antimicrobial-resistant strains and genes in nature and especially between humans and animals.

The concern over antibiotic-resistant bacteria producing human infections that are difficult to treat has led to a proliferation of studies in recent years investigating resistance in livestock, food products, the environment and people, as well as in the mechanisms of transfer of the genetic elements of resistance between bacteria, and the routes, or risk pathways, by which the spread of resistance might occur. The possibility of transfer of resistant genetic elements between bacteria in mixed populations adds many additional and complex potential routes of spread. There is now considerable evidence that transfer of antimicrobial resistance from food-producing animals to humans directly via the food chain is a likely route of spread. The application of animal wastes to farmland and subsequent leaching into watercourses has also been shown to lead to many potential, but less well-documented, pathways for spread. Often, however, where contamination of water sources, processed foods, and other environmental sites is concerned, specific routes of circulation are unclear and may well involve human sources of contamination. Examination of water sources in particular may be difficult due to dilution and their natural flow. Also, as meat is comparatively easy to examine, and is frequently suspected of being a source of spread, there is some bias in favour of studying this vehicle. Such complexities mean that, with the evidence currently available, it is not possible to prioritise the importance of potential risk pathways and circulation routes.