A one health nanotechnologies approach to address antimicrobial resistance: state of the art and strategic outlook

Abstract

Antimicrobial resistance (AMR) is one of the top global concerns for public health. According to WHO estimates, AMR was responsible for 4.95 million deaths in 2019. AMR occurs when bacteria, fungi, viruses, and other pathogens cease to respond to conventional drugs and antimicrobial agents, acquired over time due to the selection pressure of overused antimicrobial agents. Consequently, these agents lose their effectiveness. Microorganisms have evolved mechanisms to prevent drug entry or deactivate them altogether. While strategies like combination therapy, bacteriophage therapy, and antimicrobial peptides have been explored to combat AMR, they are fraught with limitations. Nanomaterial-based approaches are emerging as powerful strategies for tackling hard-to-treat bacterial infections, especially those involving antibiotic resistance. Their distinctive nanoscale dimensions and physicochemical properties enable them to bypass conventional resistance mechanisms and effectively disrupt resilient bacterial communities such as biofilms. This capability may mitigate concurrent mutations in microorganisms that lead to resistance. Combining traditional antibiotics with nanocarriers has demonstrated enhanced efficacy against drug-resistant bacteria. Moreover, nanomaterials facilitate improved delivery of antimicrobial drugs and help prevent the development of resistance. This review explores the diverse modes of action through which nanomaterials combat antibiotic-resistant bacteria and biofilm-associated infections. It also discusses how specific design features can be optimized to improve antimicrobial efficacy. In addition, this review examines recent advancements in innovative nanotechnologies targeting drug-resistant pathogens and assesses their potential and practicality for integration into next-generation antimicrobial therapies. Finally, we examine recent advancements in this field and address key challenges that must be overcome to facilitate the clinical translation of nanomaterial-based antimicrobial therapies.