Global Patterns, Drivers, and Mechanisms of Antimicrobial Resistance: A Systematic Evidence-Mapping Review of Clinical and One-Health Settings

Abstract

Background: Antimicrobial resistance (AMR) has emerged as one of the most critical threats to global public health, compromising the effective treatment of bacterial infections and increasing morbidity, mortality, and healthcare costs. Despite extensive research, AMR data remain fragmented across regions, pathogens, and healthcare sectors, necessitating a comprehensive synthesis of current evidence. Methods: A systematic search of major scientific databases identified 150 records. After screening and eligibility assessment, 100 studies were included. Data were extracted on study setting, geographic region, bacterial pathogens, resistance mechanisms, antibiotic classes, and preventive strategies. An evidence-mapping framework was used to synthesize qualitative trends and identify dominant AMR drivers across clinical, community, animal, and environmental domains. Results: The reviewed studies consistently highlighted Enterobacterales, Staphylococcus aureus, and multidrug-resistant non-fermenters (Pseudomonas aeruginosa and Acinetobacter baumannii) as the principal contributors to the AMR burden. β-lactamase-mediated resistance, carbapenem resistance, efflux mechanisms, loss of permeability, and plasmid-mediated horizontal gene transfer were the most frequently reported molecular mechanisms. Hospital and intensive-care environments, excessive antibiotic consumption, inadequate infection-prevention practices, and cross-sector transmission were repeatedly identified as major amplifiers of the dissemination of resistance. Conclusion: AMR is sustained by a complex interaction of microbial, clinical, and environmental factors. Integrated antimicrobial stewardship, strengthened infection-control measures, and One-Health–based surveillance systems are urgently required to mitigate the escalating global resistance crisis. Bangladesh J Medicine 2026; 37(3): 192-201