When the challenge of antimicrobial resistance (AMR) intensifies, our attention typically gravitates toward familiar culprits: the overuse of antibiotics in medicine and agriculture, lapses in hospital infection control, and fragmented surveillance systems. These are undeniably critical battlegrounds. Yet this focus often obscures a more complex, systemic crisis—one where AMR is not merely a clinical or pharmaceutical challenge but an environmental one as well.
Scientific evidence is increasingly highlighting a pervasive and often overlooked accomplice in the AMR crisis: microplastics.
The Ubiquitous Threat: A Plastic-Coated World
Microplastics—plastic fragments smaller than five millimetres—have become widespread contaminants in nearly every ecosystem on Earth. An estimated 14mn tonnes of plastic waste enter our oceans and soils annually, a figure projected to rise to 29 million tonnes by 2040. Factoring in existing microplastics, their environmental burden could swell to an enormous 600mn tonnes within the same timeframe.
While the ecological damage to biodiversity and the human health risks from ingesting microplastics have long been flagged by environmentalists, an even more alarming role is now emerging: microplastics as breeding grounds and transport systems for antibiotic-resistant bacteria.
How Tiny Plastics Foster Mighty Resistance
Recent research paints a concerning picture of how these minuscule particles contribute to antimicrobial resistance (AMR). One key mechanism is through the formation of biofilms—dense, slimy colonies of bacteria that cling to plastic surfaces. A pivotal study from Boston University showed that Escherichia coli (E. coli) exposed to microplastics and their biofilms rapidly developed resistance to multiple antibiotics. These biofilms act as shields, protecting bacteria from environmental threats, including the very antibiotics designed to eliminate them, thereby significantly elevating their multidrug resistance.
Moreover, plastic-hosted biofilms are hotspots for genetic exchange. Research from Nanjing Tech University and Zhejiang University revealed that polystyrene-based microplastics—notably used in disposable containers—carry microbial colonies and harbour "floating" genetic materials, including antibiotic resistance genes (ARGs). Within these crowded biofilms, bacteria can easily share antibiotic resistance genes (ARGs) via horizontal gene transfer (HGT), thereby accelerating the spread of resistance.
Beyond fostering resistance, common plastics like polyethylene, polypropylene and polystyrene serve as transport systems—or vectors—for well-known drug-resistant bacteria such as Pseudomonas aeruginosa and Klebsiella pneumoniae. These pathogens don't just survive on plastic surfaces—they thrive, protected by biofilms that enhance their resilience against environmental stresses and antimicrobial agents.
Wastewater Systems: The Unseen Nexus of Pollution and Resistance
One of the most critical yet under-discussed accelerants in this equation is our global wastewater infrastructure. Wastewater treatment plants (WWTPs) serve as convergence points for antibiotics and microplastics shed from numerous products, as well as diverse microbial communities.
Even advanced filtration systems aren’t foolproof. It’s estimated that around 10% of microplastics bypass treatment and enter rivers, lakes and oceans—carrying their microbial cargo with them. Simultaneously, the persistent presence of antibiotic residues in wastewater creates ideal conditions for resistant strains to survive and for horizontal gene transfer (HGT) to flourish.
The European Environment Agency has flagged WWTPs as primary hotspots for both antibiotic residues and microplastics laden with ARGs. Where secondary or tertiary treatment is inadequate—a reality in much of the world—these facilities effectively become conduits, releasing resistant bacteria and gene-carrying microplastics into downstream ecosystems. This is especially alarming given that 67% of the global population lacks access to proper sewage systems, and nearly 20% of wastewater receives no secondary treatment—most notably in low-income countries.
Recalibrating Our Global AMR Strategy: A Wider Lens is Crucial
As the global community contends with AMR—arguably one of the most severe public health threats of the 21st century—it is imperative to broaden our strategic lens. The emergence of microplastics as potent carriers and facilitators of resistance genes signals a critical intersection between environmental pollution and global health security.
Current regulations targeting microplastics are primarily focused on pollution control. They often fail to account for public health ramifications and the links to AMR. Growing evidence suggests a shift toward cross-sectoral strategies. AMR mitigation can no longer remain confined to hospitals and pharmaceutical stewardship—it must encompass robust environmental management, responsible industrial practices, and comprehensive waste and wastewater treatment infrastructure.
Navigating the Path Forward: Pragmatism and Prioritised Action
We must acknowledge a practical reality: certain single-use plastics—particularly in medical packaging and devices—remain indispensable for ensuring sterility and accessibility in life-saving treatments, especially in resource-limited settings. A blanket phase-out is neither feasible nor advisable without viable, scalable and equally safe alternatives.
Instead, we need a multi-pronged approach, beginning with post-use management. Effective collection, sorting and disposal systems must be implemented across the plastic lifecycle. Simultaneously, we must accelerate innovation in recycling by investing in technologies capable of processing a broader range of plastics and reducing environmental leakage.
Curbing the uncontrolled release of plastic waste, particularly microplastics, also means improving product design, refining industrial processes, and influencing consumer behaviour. Upgrading global wastewater infrastructure must be a top priority, as it enhances the ability of treatment plants to remove both microplastics and antibiotic-resistant genes (ARGs). In tandem, integrated environmental surveillance systems should be developed to monitor microplastic pollution and ARG prevalence in a coordinated and actionable manner.
Strengthening our environmental defence against plastic pollution is no longer just an ecological imperative. It is central to any comprehensive, systems-level response to the antimicrobial resistance (AMR) crisis. The hidden role of microplastics as accelerants of resistance is coming into sharper focus. It’s time we gave them a seat at the AMR table—and acted accordingly.
(The author is President of Global Critical Care, Venus Remedies and CEO of Venus Medicine Research Centre. He leads research and global strategy, with a focus on antimicrobial resistance and sustainable healthcare systems.)
