The role of the natural environment in the emergence of antibiotic resistance in Gram-negative bacteria

Elizabeth M.H. Wellington*, Alistair B.A. Boxall, Paul Cross, Edward J. Feil, William H. Gaze, Peter M. Hawkey, Ashley S. Johnson-Rollings, Davey L. Jones, Nicholas M. Lee, Wilfred Otten, Christopher M. Thomas, A. Prysor Williams

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

794 Citations (Scopus)


During the past 10 years, multidrug-resistant Gram-negative Enterobacteriaceae have become a substantial challenge to infection control. It has been suggested by clinicians that the effectiveness of antibiotics is in such rapid decline that, depending on the pathogen concerned, their future utility can be measured in decades or even years. Unless the rise in antibiotic resistance can be reversed, we can expect to see a substantial rise in incurable infection and fatality in both developed and developing regions. Antibiotic resistance develops through complex interactions, with resistance arising by de-novo mutation under clinical antibiotic selection or frequently by acquisition of mobile genes that have evolved over time in bacteria in the environment. The reservoir of resistance genes in the environment is due to a mix of naturally occurring resistance and those present in animal and human waste and the selective effects of pollutants, which can co-select for mobile genetic elements carrying multiple resistant genes. Less attention has been given to how anthropogenic activity might be causing evolution of antibiotic resistance in the environment. Although the economics of the pharmaceutical industry continue to restrict investment in novel biomedical responses, action must be taken to avoid the conjunction of factors that promote evolution and spread of antibiotic resistance.

Original languageEnglish
Pages (from-to)155-165
Number of pages11
JournalThe Lancet Infectious Diseases
Issue number2
Publication statusPublished - Feb 2013
Externally publishedYes

Bibliographical note

Funding Information:
We thank reviewers for their helpful comments. We acknowledge financial support from the Natural Environment Research Council (NERC) project NE/E004482/1.


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