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Compa a i e S udy o An imic obial
Resis ance in U ban s Ru al A eas
Nupu a Joshi
Assis an P o esso , Depa men o Mic obiology, Abasaheb Ga wa e College, Pune, India.
Abs ac : An imic obial esis ance (AMR) is a g owing global heal h conce n, d i en by complex in e ac ions ac oss clinical, en i onmen al,
and socioeconomic domains. While much esea ch has ocused on AMR p e alence in u ban heal hca e se ings, u al en i onmen s—o en
lacking s uc u ed su eillance—a e eme ging as c i ical ese oi s o esis ance genes. This pape p esen s a compa a i e s udy o AMR pa e ns
in u ban e sus u al a eas, syn hesizing ecen esea ch on clinical isola es, en i onmen al samples, li es ock-associa ed esis ance, and socio-
beha io al d i e s. The analysis e eals highe de ec ion o ex ended-spec um be a-lac amase (ESBL) and ca bapenem- esis an o ganisms in
u ban hospi als, while u al egions show ele a ed le els o en i onmen al and zoono ic ansmission o esis an bac e ia, o en linked o
ag icul u al uno , poo was e managemen , and in o mal an ibio ic use. Socioeconomic dispa i ies u he exace ba e esis ance by a ying
hygiene, heal hca e access, and awa eness. The s udy unde sco es he impo ance o adop ing a One Heal h app oach and imp o ing AMR
su eillance and s ewa dship s a egies ailo ed o he speci ic isks o bo h u ban and u al con ex s.
Keywo ds: An imic obial esis ance, One Heal h, Ru al heal h, Socioeconomic ac o s, U ban- u al compa ison.
1 INTRODUCTION
An imic obial esis ance (AMR) poses a se ious h ea o public heal h wo ldwide, unde mining decades o p og ess in ea ing
in ec ious diseases. As pa hogens e ol e o esis commonly used an ibio ics, in ec ions become ha de o ea , leading o
inc eased mo bidi y, mo ali y, and heal hca e cos s. The Wo ld Heal h O ganiza ion (WHO) has decla ed AMR as one o he op
10 global public heal h h ea s [1]. T adi ionally, he ocus o AMR su eillance and esea ch has been cen e ed on u ban heal hca e
se ings, whe e he densi y o clinical acili ies and an ibio ic usage is highe . Howe e , eme ging s udies highligh ha u al
en i onmen s a e also signi ican con ibu o s o he sp ead o AMR, pa icula ly h ough ag icul u al p ac ices, poo was e
disposal, and un ea ed en i onmen al discha ges [2][3]. The con as be ween u ban and u al d i e s o AMR is s a k—u ban
a eas end o show high clinical esis ance due o an ibio ic o e use and hospi al-acqui ed in ec ions, while u al a eas o en exhibi
esis ance linked o en i onmen al con amina ion, zoono ic ansmission, and un egula ed an ibio ic consump ion in li es ock
[4][5].
Recen in es iga ions ha e e ealed widesp ead esis ance o c i ical an ibio ics, including ca bapenems, colis in, and hi d-
gene a ion cephalospo ins, in bo h u ban hospi als and u al communi ies [6][7]. En i onmen al s udies show ha i e s in u al
egions se e as ese oi s o an ibio ic- esis an genes (ARGs), o en d i en by hyd ological and land-use ac o s [2][3]. In
con as , u ban a eas expe ience ele a ed isk due o heal hca e-associa ed ansmission and poo an imic obial s ewa dship in
o e c owded acili ies [6][8]. The u ban– u al di ide also ex ends o socioeconomic dimensions. Fac o s such as income le els,
educa ion, heal hca e in as uc u e, sani a ion, and hygiene p ac ices signi ican ly in luence AMR dynamics in bo h se ings
[1][9].
Addi ionally, su eillance and diagnos ic capaci ies di e widely, esul ing in knowledge gaps and delayed esponses,
pa icula ly in low- and middle-income coun ies [6][5]. This pape aims o p o ide a compa a i e analysis o AMR in u ban and
u al a eas by syn hesizing indings om en i onmen al, clinical, and socioeconomic s udies. The goal is o iden i y key
di e ences, o e laps, and d i e s o esis ance pa e ns ac oss hese se ings, and o p opose con ex -speci ic s a egies o AMR
su eillance, con ol, and policy-making wi hin a One Heal h amewo k.
2 LITERATURE REVIEW
An imic obial esis ance (AMR) is a mul i ac o ial issue shaped by clinical, en i onmen al, ag icul u al, and social d i e s.
The con as be ween u ban and u al AMR pa e ns has gained inc eased esea ch a en ion in ecen yea s, pa icula ly h ough
One Heal h s udies ha in eg a e human, animal, and en i onmen al heal h da a.
2.1 En i onmen al Rese oi s and Ri e ine AMR in Ru al Se ings
Robins e al. [2] compa ed wo u al i e ca chmen s in No he n England using quan i a i e mic obial p o iling and ound
signi ican ly highe ARG abundance and di e si y in he Eden Ri e compa ed o he Coque .
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Hyd ological ac o s and ag icul u al uno we e iden i ied as majo con ibu o s o en i onmen al AMR, unde lining he
in luence o geog aphical and land-use cha ac e is ics in u al AMR dissemina ion. Simila ly, Naznine e al. [3] emphasized i e s
as key ese oi s o AMR ansmission due o con amina ion om hospi al, municipal, and indus ial was e. These indings show
ha u al wa e bodies— hough o en dis an om hospi als—can ha bo clinically ele an esis ance genes.
2.2 Ag icul u al An ibio ic Use and AMR in Ru al Li es ock
Mba idde e al. [4] in es iga ed poul y a ms in Uganda and epo ed he widesp ead p esence o colis in- and ce o axime-
esis an E. coli in bo h semi-in ensi e and ee- ange sys ems. E en in he absence o di ec co ela ions be ween an ibio ic use
and esis ance, he s udy ound mul id ug- esis an s ains in u al se ings, sugges ing en i onmen al o indi ec d i e s. Alam e
al. [10] u he illus a ed he isks o AMR in Bangladesh’s small-scale poul y a ms, whe e poo hygiene and was e-disposal
p ac ices inc eased human exposu e o esis an bac e ia h ough soil and wa e pa hways.
2.3 Clinical Resis ance in U ban Heal hca e Se ings
U ban a eas o en epo a highe p e alence o clinically signi ican AMR due o hospi al-acqui ed in ec ions and equen
an ibio ic use. Gach e al. [6] conduc ed a sys ema ic e iew in Indonesia and no ed high le els o ca bapenem esis ance in
Klebsiella pneumoniae and Acine obac e baumannii, especially in hospi al samples. Simila ly, ALjohni e al. [5] epo ed
inc easing esis ance among E. coli s ains p oducing ex ended-spec um be a-lac amases (ESBLs) and ca bapenemases,
highligh ing he public heal h bu den in u ban heal hca e sys ems. Seni e al. [11] also epo ed ha e e al hospi als had
signi ican ly highe esis ance a es han lowe - ie heal hca e acili ies in Tanzania.
2.4 One Heal h and C oss-Sec o al Genomic S udies
Calland e al. [7] implemen ed a One Heal h genomic app oach in Ghana, compa ing Klebsiella isola es om human, animal,
and en i onmen al samples. The esul s e ealed ha hospi al s ains had a highe p e alence o ESBL genes, while en i onmen al
samples om u al sou ces we e less esis an . This ein o ced he concep ha clinical se ings a e p ima y ho spo s o c i ical
esis ance ai s, al hough gene low ac oss domains emains a conce n. These insigh s suppo a ge ed in e en ions a heal hca e
cen e s while also ecognizing en i onmen al con ibu ions.
2.5 Socioeconomic and Policy D i e s
AMR is no only a biological issue bu also a social one. Ljungq is e al. [1] pe o med an umb ella e iew o map
socioeconomic d i e s o AMR, highligh ing key a iables such as u banici y, heal hca e access, hygiene, and po e y. Di e ences
in public awa eness, an ibio ic a ailabili y, and sani a ion se ices be ween u al and u ban popula ions in luence he de elopmen
and ansmission o esis ance. Ve ma e al. [8] e alua ed an an imic obial s ewa dship p og amme in an u ban auma cen e in
No h India, demons a ing how policy and su eillance gaps can be add essed h ough a ge ed hospi al in e en ions.
2.6 P edic i e Tools and Machine Lea ning Applica ions
Wu e al. [9] in oduced machine lea ning echniques o es ima e ela i e AMR isk in aqua ic en i onmen s based on land-use
and en i onmen al pa ame e s. Among he algo i hms es ed, andom o es s p o ided he mos accu a e p edic ions. These models
o e p ac ical alue o p edic ing AMR ho spo s in bo h u al and u ban wa e sys ems, whe e ou ine moni o ing may be limi ed.
The e iewed li e a u e clea ly shows ha AMR pa e ns a e con ex -dependen : u ban a eas a e domina ed by clinical and
nosocomial esis ance, while u al se ings exhibi esis ance a ising om en i onmen al and ag icul u al pa hways. These indings
collec i ely suppo a mul idimensional, One Heal h pe spec i e o unde s and and mi iga e AMR isks [12].
3 METHODOLOGY
This s udy adop s a compa a i e, e iew-based me hodology o syn hesize and analyze pa e ns o an imic obial esis ance
(AMR) ac oss u ban and u al con ex s, using a One Heal h amewo k. Ra he han conduc ing p ima y expe imen s o da a
collec ion, his pape sys ema ically examines exis ing pee - e iewed s udies and da ase s ac oss en i onmen al, clinical,
ag icul u al, and socioeconomic domains o iden i y ends, con as s, and key d i e s o AMR.
3.1 Selec ion o S udies
Ten ecen and high-quali y s udies we e selec ed based on he ollowing c i e ia:
• Pee - e iewed jou nal a icles published be ween 2019 and 2025.
• Resea ch ocusing on AMR in en i onmen al (e.g., i e sys ems), clinical (e.g., hospi als), ag icul u al (e.g., poul y
a ms), o communi y se ings.
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• S udies o e ing compa a i e insigh s in o u ban and u al dynamics o AMR o o e ing da a ha could be in e p e ed
h ough his lens.
• Inclusion o da a om bo h high-income and low- and middle-income coun ies o accoun o geog aphic and
socioeconomic a iabili y.
The selec ed s udies we e analyzed o :
• P e alence and ypes o an imic obial- esis an o ganisms o genes.
• En i onmen al o clinical sou ces o AMR.
• Socioeconomic o beha io al d i e s o esis ance.
• Su eillance, diagnos ic, o s ewa dship p ac ices.
3.2 Analy ical F amewo k
The compa a i e analysis was conduc ed unde ou hema ic axes:
• Clinical AMR P e alence: Resis ance pa e ns in heal hca e se ings, s a i ied by le el o ca e (p ima y s e ia y) and
loca ion (u ban s u al).
• En i onmen al and Ag icul u al Sou ces: Role o i e s, poul y a ming, and was e disposal in u al AMR dynamics.
• Socioeconomic and Beha io al In luences: Fac o s such as hygiene p ac ices, an ibio ic knowledge, and heal hca e
accessibili y.
• Su eillance and Policy Implemen a ion: Di e ences in AMR moni o ing and esponse mechanisms be ween u ban and
u al a eas.
Da a ex ac ed om each s udy we e na a i ely syn hesized and g ouped o highligh u ban– u al con as s in AMR p esence,
d i e s, and ou comes.
3.3 Limi a ions
As a e iew-based s udy, his wo k is subjec o ce ain limi a ions. The a ailabili y o uni o m da a ac oss u ban and u al
con ex s is limi ed in some egions, pa icula ly in low-income se ings. Mo eo e , a ia ions in s udy design, sampling s a egies,
and labo a o y me hodologies ac oss he e e enced li e a u e may a ec di ec compa abili y. No o iginal labo a o y es ing o
ield sampling was conduc ed o his s udy.
4 COMPARATIVE ANALYSIS: URBAN VS RURAL AMR PATTERNS
The bu den o an imic obial esis ance (AMR) mani es s di e en ly ac oss u ban and u al a eas due o dis inc en i onmen al
exposu es, an ibio ic usage pa e ns, heal hca e in as uc u e, and socioeconomic dynamics. Based on he li e a u e e iewed, his
sec ion ou lines compa a i e ends ac oss key domains con ibu ing o AMR eme gence and sp ead.
4.1 Clinical AMR P e alence
U ban heal hca e sys ems, pa icula ly e ia y hospi als, end o epo a highe incidence o d ug- esis an in ec ions due o
equen use o b oad-spec um an ibio ics and poo an imic obial s ewa dship. Gach e al. [6] obse ed ala ming le els o
esis ance in Klebsiella pneumoniae and Acine obac e baumannii in Indonesian hospi als, wi h inc easing ends o e ime.
Simila ly, ALjohni e al. [5] highligh ed he g owing h ea o ex ended-spec um be a-lac amase (ESBL) and ca bapenem- esis an
E. coli in clinical en i onmen s. In u al heal hca e se ings, esis ance is o en unde epo ed due o limi ed diagnos ic capaci y
and su eillance. Howe e , s udies such as ha by Seni e al. [11] show ha e en lowe - ie u al heal hca e acili ies in Tanzania
epo signi ican esis ance, wi h hi d-gene a ion cephalospo in- esis an s ains becoming inc easingly common. Al hough
o e all clinical exposu e may be lowe in u al a eas, inapp op ia e p esc ibing p ac ices and delayed diagnoses con ibu e o he
de elopmen and ansmission o esis ance.
4.2 En i onmen al and Ag icul u al Sou ces o Resis ance
Ru al a eas, despi e lowe clinical an ibio ic use, o en se e as ese oi s o esis ance due o en i onmen al con amina ion.
Robins e al. [2] demons a ed signi ican ly highe ARG abundance in i e s wi h g ea e ag icul u al uno and hyd ological
connec i i y. Ag icul u al p ac ices, including he un egula ed use o an ibio ics in poul y and li es ock, con ibu e o ese oi s
o esis ance in u al soils and wa e bodies [4][10]. En i onmen al s udies, such as hose by Naznine e al. [5], ha e emphasized
ha i e s and open d ains se e as condui s o ho izon al gene ans e , enabling he sp ead o esis ance genes ac oss mic obial
popula ions. Was e disposal om a ms and he en y o animal was e in o aqua ic sys ems ampli y hese isks.
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In con as , while u ban i e s also con ain ARGs, hese a e mo e commonly linked o sewage discha ges and hospi al e luen s
a he han ag icul u al inpu s.
4.3 Socioeconomic and Beha io al Fac o s
Socioeconomic dispa i ies signi ican ly shape AMR isks. U ban popula ions may ha e be e access o heal hca e and public
awa eness campaigns bu a e also exposed o high- isk en i onmen s such as hospi als and c owded esiden ial se ings. Ru al
popula ions, on he o he hand, o en engage in sel -medica ion, use le o e an ibio ics, o pu chase an imic obials wi hou
p esc ip ions due o limi ed heal hca e access. Ljungq is e al. [1] mapped a ange o socioeconomic d i e s, including u banici y,
sani a ion, educa ion, and income. Thei e iew e ealed ha low educa ional a ainmen and poo hygiene p ac ices—common in
u al a eas—a e associa ed wi h highe isk o AMR de elopmen . Alam e al. [9] u he highligh ed unsa e handling and was e-
disposal p ac ices in u al poul y a ming, he eby inc easing human exposu e o esis an o ganisms.
4.4 Su eillance, Policy, and S ewa dship Gaps
U ban a eas gene ally bene i om cen alized su eillance sys ems, an imic obial s ewa dship p og ammes, and egula o y
mechanisms. Ve ma e al. [8] showed signi ican imp o emen in an imic obial p esc ip ion pa e ns ollowing he implemen a ion
o a hospi al-based s ewa dship p og amme in No h India. Howe e , he each o such ini ia i es is o en limi ed o u ban e ia y
cen e s. Ru al a eas su e om agmen ed o non-exis en su eillance. Calland e al. [7] ound ha al hough esis ance genes
we e p esen in u al en i onmen al samples in Ghana, c i ical clinical esis ance genes we e la gely es ic ed o hospi al samples.
This indica es bo h he need o imp o ed diagnos ics in u al clinics and he u gency o en i onmen al in e en ions.
P edic i e models, such as hose de eloped by Wu e al. [9], o e p omise o bo h se ings by iden i ying high- isk zones o
AMR based on en i onmen al and land-use ea u es. These ools can guide su eillance e o s whe e con en ional in as uc u e
is lacking. This compa a i e analysis unde sco es he complexi y o AMR dynamics. While u ban a eas bea he b un o clinically
ele an esis ance, u al en i onmen s emain pe sis en , o en o e looked sou ces o en i onmen al and zoono ic AMR. E ec i e
in e en ion equi es pa allel s a egies ailo ed o he unique isks o bo h u ban and u al ecosys ems.
5 DISCUSSION
The compa a i e syn hesis o he li e a u e e eals ha an imic obial esis ance (AMR) is shaped by di e se ac o s, wi h u ban
and u al se ings exhibi ing dis inc ye in e connec ed isk p o iles. While clinical se ings in u ban a eas a e p ima y si es o
mul id ug- esis an in ec ions, u al a eas con ibu e subs an ially h ough en i onmen al and ag icul u al pa hways, o en in he
absence o s uc u ed su eillance o egula o y amewo ks. In u ban se ings, high pa ien u no e in hospi als, equen
an ibio ic use, and inadequa e s ewa dship policies d i e he eme gence and sp ead o esis an pa hogens. S udies consis en ly
show ele a ed esis ance o ca bapenems, colis in, and hi d-gene a ion cephalospo ins in hospi al-acqui ed in ec ions [6][5].
Howe e , hese en i onmen s also o e oppo uni ies o a ge ed in e en ions, such as an imic obial s ewa dship p og ams [8],
which ha e p o en e ec i e in imp o ing p esc ip ion pa e ns and educing esis ance a es.
Ru al a eas, in con as , a e cha ac e ized by decen alized heal hca e sys ems, limi ed diagnos ic capabili ies, and widesp ead
in o mal an ibio ic use. En i onmen al ec o s—such as con amina ed i e s and ag icul u al uno —play a dominan ole in he
p opaga ion o AMR. As shown in s udies om England, Uganda, and Bangladesh [2][4][10], u al i e s and poul y a ms o en
con ain high le els o ARGs and esis an bac e ia, sugges ing long- e m en i onmen al ese oi s o AMR. Ano he majo
dis inc ion lies in beha io al and socioeconomic de e minan s. U ban popula ions o en ha e highe access o egula ed heal hca e
bu ace inc eased exposu e o clinical AMR. Ru al popula ions a e mo e likely o sel -medica e o ely on un ained p o ide s,
exace ba ing he misuse o an ibio ics. The e iew by Ljungq is e al. [1] highligh s he need o public educa ion and beha io
change in e en ions ailo ed o di e en communi y con ex s.
Fu he mo e, policy and su eillance gaps in u al a eas delay de ec ion and esponse o AMR ou b eaks. While u ban cen e s
a e ypically included in na ional AMR su eillance ne wo ks, u al egions emain unde ep esen ed. As such, eme ging AMR
ho spo s in u al a eas may go unno iced un il hey each clinical se ings. Table 1 summa izes he key compa a i e dimensions
be ween u ban and u al AMR pa e ns.
In bo h con ex s, a One Heal h app oach is essen ial. The mo emen o esis ance genes and bac e ia be ween human, animal,
and en i onmen al ese oi s necessi a es in eg a ed solu ions. Fo ins ance, hospi al-based in e en ions mus be complemen ed
by policies a ge ing an imic obial use in ag icul u e, en i onmen al moni o ing, and public educa ion, pa icula ly in u al
communi ies. Machine lea ning models, like hose p oposed by Wu e al. [9], can enhance su eillance by p edic ing AMR ho spo s
based on en i onmen al a iables. These ools a e especially aluable in low- esou ce u al se ings, whe e con en ional
moni o ing is challenging.
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Table 1. Compa a i e O e iew o AMR Cha ac e is ics in U ban s Ru al A eas
Dimension
U ban A eas
Ru al A eas
P ima y AMR Sou ces
Hospi als, sewage e luen s, densely
popula ed a eas
Ri e s, li es ock a ms, in o mal heal hca e,
ag icul u al uno
Common Resis an
Pa hogens
ESBL- and ca bapenem- esis an E. coli, K.
pneumoniae, A. baumannii
E. coli, Salmonella, en i onmen al bac e ia wi h
ARGs
An ibio ic Use Pa e ns
F equen , o en egula ed; hospi al-based
p esc ip ions
O en un egula ed; use in li es ock and sel -
medica ion
Su eillance Co e age
Mode a e o high; pa o na ional AMR
ne wo ks
Low o absen ; unde epo ed and poo ly
moni o ed
Socioeconomic D i e s
High densi y, be e access o heal h
in as uc u e
Limi ed educa ion, sani a ion, and heal hca e
access
AMR In e en ions
S ewa dship p og ams, in ec ion con ol,
diagnos ics
Limi ed in e en ions; need o en i onmen al
and communi y-le el ac ions
Add essing AMR equi es con ex -speci ic s a egies ha ecognize he di e ing ye in e connec ed d i e s in u ban and u al
ecosys ems. Equi y in su eillance, egula ion, and heal hca e in as uc u e is c i ical o managing he AMR h ea on a na ional
and global scale.
6 CONCLUSIONS AND RECOMMENDATIONS
An imic obial esis ance (AMR) is a global public heal h conce n ha mani es s di e en ly ac oss u ban and u al se ings due
o a ia ions in clinical p ac ices, en i onmen al exposu es, an ibio ic use pa e ns, and socioeconomic ac o s. This compa a i e
s udy highligh s ha while u ban a eas ace a concen a ed bu den o clinically signi ican esis an in ec ions—pa icula ly in
hospi al se ings— u al a eas se e as pe sis en and o en o e looked ese oi s o esis ance, d i en by en i onmen al
con amina ion and ag icul u al an ibio ic use. U ban egions end o bene i om s uc u ed su eillance sys ems, es ablished
s ewa dship p o ocols, and be e heal hca e access. Howe e , high an ibio ic consump ion, inadequa e in ec ion con ol, and
o e bu dened hospi als con ibu e o he apid eme gence and dissemina ion o esis an pa hogens. Con e sely, u al egions
su e om limi ed diagnos ic capaci y, poo sani a ion, and widesp ead in o mal an ibio ic use, all o which c ea e a o able
condi ions o en i onmen al and zoono ic ansmission o AMR.
Based on his analysis, he ollowing key ecommenda ions a e p oposed:
1. Expand AMR Su eillance o Ru al A eas - Na ional AMR moni o ing sys ems mus inco po a e u al en i onmen al and
communi y heal h da a o ensu e ea ly de ec ion and localized in e en ions.
2. S eng hen An imic obial S ewa dship in All Heal hca e Se ings - S ewa dship p og ams should be scaled o include
u al clinics and in o mal p o ide s, suppo ed by aining and s anda dized guidelines.
3. Regula e and Moni o An ibio ic Use in Ag icul u e - En o cemen o egula ions on e e ina y an ibio ics, combined
wi h awa eness campaigns o a me s, is essen ial o limi ag icul u al con ibu ions o AMR.
4. P omo e Public Educa ion and Communi y Engagemen - Tailo ed educa ional campaigns should add ess sel -
medica ion, hygiene, and a ional an ibio ic use, especially in low-li e acy u al popula ions.
5. Suppo Resea ch and P edic i e Modeling - In es men in en i onmen al mic obiology and machine lea ning ools can
help iden i y eme ging AMR ho spo s and in o m isk-based decision-making.
6. Adop a One Heal h App oach Ac oss Policy Le els - AMR con ainmen s a egies mus in eg a e human, animal, and
en i onmen al heal h sec o s o a holis ic esponse, pa icula ly a he local go e nance le el.
E ec i e AMR con ol equi es equi able in es men in in as uc u e, educa ion, policy, and esea ch ac oss bo h u ban and
u al a eas. B idging he su eillance and esponse gap be ween hese egions is c i ical o p e en ing he silen sp ead o esis ance
and ensu ing long- e m public heal h secu i y.
In e na ional Jou nal o Eme ging Resea ch in Science, Enginee ing, and Managemen
Vol. 1, Issue 2, pp.26-31, Augus 2025.
www.ije sem.com eISSN – 3107-9075
IJERSEM@2025 h ps://doi.o g/10.58482/ije sem. 1i2.5 31
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