Raw Milk as a Vehicle for Antimicrobial-Resistant Pathogens: Emerging Public Health Risks from a One Health Perspective

Raw-milk and raw dairy products remain a high-sensitivity One Health interface because they bypass a major microbial control step and may carry viable foodborne pathogens, bacteria exhibiting antimicrobial resistance (AMR), and AMR genes from dairy animals, farm environments, milking equipment, handlers, storage systems, and informal or direct-sale chains. This narrative review synthesizes verified scientific evidence on raw milk as a potential vehicle pathway for resistant foodborne pathogens, clinically relevant opportunistic bacteria, indicator organisms, and AMR determinants, and evaluates AMR-related emerging public health risks through a One Health perspective. The review integrates evidence from outbreak investigations, raw milk and raw dairy surveillance, culture-based antimicrobial susceptibility testing, polymerase chain reaction (PCR), whole-genome sequencing (WGS), metagenomics, metaproteomics, risk assessment, and the consumer-risk literature. The synthesis shows that raw-milk-associated AMR evidence should be interpreted by inference level rather than by a single organism or global prevalence estimate. Public health concern becomes stronger when detection or occurrence is supported by viable recovery, plausible consumer exposure, transmission linkage, infection or colonization evidence, source-attribution data, or quantified burden estimates. Evidence is strongest for exposure pathways involving Campylobacter, extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, methicillin-resistant Staphylococcus aureus (MRSA), Salmonella, Listeria, Enterococcus, Yersinia, and raw-milk resistomes, although causal strength differs across organism groups and study designs. The review distinguishes detection or occurrence, viable recovery, potential exposure, transmission, infection or colonization, source attribution, and attributable AMR burden. One Health control requires mastitis prevention, prudent antimicrobial use, milking hygiene, environmental monitoring, pasteurization or equivalent exposure barriers, WGS-supported outbreak investigation, integrated surveillance, and targeted risk communication.