Heavy metal-induced selection and proliferation of antibiotic resistance: A review

Antibiotic resistance is recognized as a global threat to public health. The selection and evolution of antibiotic resistance in clinical pathogens were believed to be majorly driven by the imprudent use of antibiotics. However, concerns regarding the same, through selection pressure by a multitude of other antimicrobial agents, such as heavy metals, are also growing. Heavy metal contamination co-selects antibiotic and metal resistance through numerous mechanisms, such as co-resistance and cross-resistance. Here, we have reviewed the role of heavy metals as antimicrobial resistance driving agents and the underlying concept and mechanisms of co-selection, while also highlighting the scarcity of studies explicitly inspecting the process of co-selection in clinical settings. Prospective strategies to manage heavy metal-induced antibiotic resistance have also been deliberated, underlining the need to find specific inhibitors so that alternate medicinal combinations can be added to the existing therapeutic armamentarium.

Automated summary

Antibiotic resistance is a global threat, driven not only by the improper use of antibiotics but also by the selection pressure from other antimicrobial agents like heavy metals. Heavy metal contamination contributes to the development of antibiotic and metal resistance through mechanisms such as co-resistance and cross-resistance. However, there is a scarcity of studies investigating the process of co-selection in clinical settings. Prospective strategies are needed to manage heavy metal-induced antibiotic resistance, including the search for specific inhibitors and the addition of alternative medicinal combinations to existing treatment options.