One Health Approach to Combat Antimicrobial Resistance in Pakistan: Integrating Human, Animal, and Environmental Surveillance

Abstract

Antimicrobial resistance is a growing One Health threat affecting human, animal, and environmental health sectors. In Pakistan, integrated surveillance data across these sectors remain limited. Understanding sectoral distribution and associated risk factors is essential for targeted control strategies. Objective: To determine the prevalence and distribution of antimicrobial resistance across human, animal, and environmental surveillance sectors in Pakistan and assess its association with bacterial species, antibiotic exposure, sanitation risk, and geography. Methods: This cross-sectional study included 30 bacterial isolates evenly selected from human, animal, and environmental surveillance sectors in Pakistan. Standard microbiological and molecular procedures were used for bacterial identification, antimicrobial susceptibility testing, and detection of selected antimicrobial resistance genes. Data were analyzed using descriptive statistics, including frequencies and percentages. Associations between antimicrobial resistance and categorical variables were assessed using Pearson’s chi-square test, while the strength of association was measured using Cramér’s V. A p-value of <0.05 was considered statistically significant. Results: Overall, 23 of 30 isolates were resistant, giving an antimicrobial resistance prevalence of 76.7%. Resistance was observed in 70.0% of human isolates and 80.0% of both animal and environmental isolates, with no significant association between resistance and surveillance sector (p=0.830). Escherichia coli was the most frequently isolated organism, accounting for 53.3% of all isolates, while blaCTX-M was the most commonly detected resistance gene. Antimicrobial resistance showed a significant association with antibiotic exposure (χ²=20.683, p<0.001; Cramér’s V=0.830) and sanitation risk (χ²=11.366, p=0.003; Cramér’s V=0.616). However, resistance status was not significantly associated with province or bacterial species. Conclusion: A high burden of antimicrobial resistance was observed across human, animal, and environmental sectors in Pakistan, supporting the need for integrated One Health surveillance. Antibiotic exposure and sanitation risk were strongly associated with resistance, highlighting the importance of antimicrobial stewardship, improved sanitation, farm biosecurity, and effective wastewater management.