One Health, No Silos: Integrating Veterinary, Human, and Environmental Stewardship Strategies to Close the AMR Diagnostic Gap

Disclosure: This is a summary of the full publication One Health, No Silos: Integrating Veterinary, Human, and Environmental Stewardship Strategies to Close the AMR Diagnostic Gap. The collaborators of this publication initially shared their knowledge and expertise at the 2025 AMR Summit in Detroit, MI. For the full publication and list of citations, please click the button above.

Summary: Antimicrobial resistance (AMR) is one of the most urgent global health threats of the 21st century, with implications extending beyond human medicine into veterinary care, agriculture, food production, and the environment. If left unaddressed, AMR is projected to cause up to 10 million deaths annually by 2050, while also creating severe economic consequences through rising healthcare costs, declining agricultural productivity, and global economic instability. The spread of resistance is driven by antimicrobial misuse and overuse across healthcare, livestock production, aquaculture, and environmental systems, making AMR a truly interconnected “One Health” challenge.

Antibiotics have transformed modern medicine and animal health since their widespread adoption in the 20th century. However, extensive use in both humans and animals has accelerated the emergence of resistant organisms. In livestock production, antimicrobials are commonly used not only for treatment, but also for disease prevention and metaphylaxis, where entire groups of animals are treated when only some are sick. While these practices can be necessary for animal welfare and food production, they also expose healthy animals to antibiotics and increase selective pressure for resistance. Antibiotics are additionally used in aquaculture and agriculture, while antimicrobial residues and resistant organisms can persist in soil, water, and food systems.

The interconnectedness of these ecosystems means resistant organisms and resistance genes move freely between humans, animals, and the environment. Early studies by Dr. Stuart Levy in the 1970s demonstrated this clearly, showing that tetracycline use in animal feed led to rapid development of resistant bacteria in both farm animals and farm workers, while reducing antibiotic use reversed resistance trends. These findings became one of the earliest demonstrations of antimicrobial stewardship (AMS), emphasizing that responsible antimicrobial use can directly impact resistance patterns.

Today, there is broad consensus that sustainable AMS requires a coordinated One Health approach integrating human health, veterinary medicine, agriculture, and environmental management. AMR is no longer viewed solely as a microbiological issue, but also as a systems and infrastructure problem requiring collaboration among clinicians, veterinarians, laboratorians, environmental scientists, policymakers, and public health experts. Despite growing awareness, stewardship efforts remain fragmented, with inconsistent standards, unequal access to diagnostics, and limited integration of surveillance systems across sectors.

Diagnostics play a foundational role in AMS because they provide the objective data necessary to guide targeted antimicrobial therapy. Culture and antimicrobial susceptibility testing (AST) allow clinicians and veterinarians to move beyond empiric prescribing toward evidence-based treatment decisions. In human healthcare, diagnostic stewardship and AMS are increasingly embedded into routine practice through accreditation requirements, standardized reporting, and regulatory oversight. However, veterinary medicine continues to face major diagnostic gaps and variation is standardization that limit stewardship effectiveness.

In veterinary settings, traditional culture and AST methods are often associated with long turnaround times, particularly in rural and livestock environments where samples must travel long distances before testing can begin. Financial limitations may also discourage diagnostic testing. As a result, veterinarians frequently rely on empiric broad-spectrum therapies, including long-acting injectable antimicrobials, without opportunities to de-escalate treatment once results become available. These practices increase selective pressure for resistance and reduce the effectiveness of stewardship interventions.

Even when AST is performed, challenges remain. Veterinary AST panels may lack important antimicrobials, standardized methodologies, or clear interpretive criteria. Reporting practices vary significantly between laboratories, and veterinary systems often lack the coordinated AMS teams common in human healthcare. Advances in rapid diagnostics and molecular technologies present significant opportunities to improve veterinary AMS by enabling faster pathogen identification and resistance detection. However, most rapid diagnostic systems are designed for human medicine and remain financially or operationally inaccessible for many veterinary laboratories.

Surveillance is another critical component of One Health AMR management. In the United States, programs such as the National Antimicrobial Resistance Monitoring System (NARMS), FDA Vet-LIRN, and the USDA National Animal Health Laboratory Network (NAHLN) support veterinary AMR surveillance by collecting AST and genomic data from animal pathogens. These efforts have enabled important discoveries, including the first detection of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) in dogs. However, veterinary surveillance remains inconsistent because laboratories may use different testing methods, follow different quality standards, or fail to report resistant organisms to public health authorities. Commercial laboratories, which process large numbers of veterinary samples, often do not participate in federal surveillance systems, further limiting data integration.

Standardization of diagnostic methods and reporting practices is therefore essential. Human clinical laboratories operate under rigorous accreditation systems that require updated breakpoints, quality control, proficiency testing, and validation procedures. Comparable expectations are less developed in veterinary medicine. Expanding harmonized standards, improving quality assurance, and strengthening laboratory infrastructure would significantly improve stewardship and surveillance capabilities across the One Health spectrum.

Education also represents a major opportunity for improvement. Veterinary schools, professional organizations, and surveillance programs can provide targeted AMS training for veterinarians, laboratorians, students, producers, and policymakers. Existing initiatives already demonstrate how education can improve antimicrobial decision-making and encourage more deliberate prescribing behaviors.

Ultimately, closing the veterinary diagnostic gap is one of the most actionable steps available to strengthen One Health stewardship. Diagnostics transform uncertainty into actionable information, allowing antimicrobials to be used more precisely and responsibly. Investments are needed in rapid diagnostics, harmonized AST methodologies, surveillance integration, laboratory infrastructure, education, and collaborative data-sharing systems. Stewardship is only as strong as the diagnostic systems that support it. Without comparable, high-quality diagnostic capacity across human, veterinary, and environmental sectors, One Health surveillance and stewardship efforts will remain incomplete. Strengthening veterinary diagnostic infrastructure is therefore not simply a technical improvement, but a necessary global intervention to preserve antimicrobial effectiveness for future generations.

Affiliations

1. Department of Pathology, Henry Ford Health System Detroit, Michigan, and College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
2. Veterinary Diagnostic Laboratory, North Dakota State University, Fargo, North Dakota, USA
3. Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA.
4. US Medical Affairs, bioMérieux, Salt Lake City, UT, USA