Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission

Maya L. Nadimpalli, Sara J. Marks, Maria Camila Montealegre, Robert H. Gilman, Monica J. Pajuelo, Mayuko Saito, Pablo Tsukayama, Sammy M. Njenga, John Kiiru, Jenna Swarthout, Mohammad Aminul Islam, Timothy R. Julian, Amy J. Pickering

Research output: Contribution to journalReview articlepeer-review

57 Citations (Scopus)


Antimicrobial resistance (AMR) is a growing public health challenge that is expected to disproportionately burden lower- and middle-income countries (LMICs) in the coming decades. Although the contributions of human and veterinary antibiotic misuse to this crisis are well-recognized, environmental transmission (via water, soil or food contaminated with human and animal faeces) has been given less attention as a global driver of AMR, especially in urban informal settlements in LMICs—commonly known as ‘shanty towns’ or ‘slums’. These settlements may be unique hotspots for environmental AMR transmission given: (1) the high density of humans, livestock and vermin living in close proximity; (2) frequent antibiotic misuse; and (3) insufficient drinking water, drainage and sanitation infrastructure. Here, we highlight the need for strategies to disrupt environmental AMR transmission in urban informal settlements. We propose that water and waste infrastructure improvements tailored to these settings should be evaluated for their effectiveness in limiting environmental AMR dissemination, lowering the community-level burden of antimicrobial-resistant infections and preventing antibiotic misuse. We also suggest that additional research is directed towards developing economic and legal incentives for evaluating and implementing water and waste infrastructure in these settings. Given that almost 90% of urban population growth will occur in regions predicted to be most burdened by the AMR crisis, there is an urgent need to build effective, evidence-based policies that could influence massive investments in the built urban environment in LMICs over the next few decades.

Original languageEnglish
Pages (from-to)787-795
Number of pages9
JournalNature Microbiology
Issue number6
Publication statusPublished - 2020 Jun 1
Externally publishedYes

ASJC Scopus subject areas

  • Microbiology
  • Immunology
  • Applied Microbiology and Biotechnology
  • Genetics
  • Microbiology (medical)
  • Cell Biology


Dive into the research topics of 'Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission'. Together they form a unique fingerprint.

Cite this