Understanding Contemporary Determinants of Antimicrobial Resistance: Towards One Health Literacy and Differentiated Responsibility

Antimicrobial resistance (AMR) is commonly framed as a consequence of antimicrobial use, yet many conditions that shape resistance arise before treatment is considered and outside clinical care. This review examines contemporary determinants of AMR across human health, animal health, food production, environmental systems, and wider social and institutional contexts. Determinants are organized around common pathways, such as infection burden, antimicrobial exposure, selection pressure, transmission, and systems’ capacity to prevent and control resistance. This pathway-based perspective helps identify critical intervention points in diagnostics, infection prevention, vaccination, water and sanitation, biosecurity, wastewater management, governance, and emergency preparedness. It also shows why surveillance conducted within separate sectors may miss interactions at human, animal, and environmental interfaces. The synthesis supports a broader understanding of AMR literacy that extends beyond knowledge and individual antibiotic behavior to include recognition of interacting determinants, opportunities for prevention, and the different capacities of actors to influence them. Shared responsibility should therefore be understood as differentiated responsibility among individuals, professionals, institutions, industry, and governments. By linking determinants with the pathways through which they act, potential points for intervention, and different levels of responsibility, this review provides a framework for more coherent One Health surveillance, prevention, preparedness, and policy responses.