Fig. 1: AMR drivers and interventions. Evolution and transmission are the two driving forces for AMR at the interface of human-animal-environment (One health interface).

AMR is generated by bacteria evolving, a process that is accelerated by selection pressure (1). Generated AMR is then transmitted across the one health interface with the aid of a range of enablers (2). To effectively combat AMR, interventions must target the two driving forces i.e., (3) Antibiotic Stewardship aimed at limiting the antibiotic use-mediated selection pressure, and (4) Infection prevention and control (IPC). We argue that there is a significant imbalance in the evidence available to inform such interventions, let alone assess their impact. The transparency of the two upward arrows indicates the levels of available evidence i.e., high transparency means low levels of evidence. The brown arrows represent the knowledge-intervention-evaluation cycle existing for each force, and thickness of the arrows indicate the proportional degree. This cycle refers to the knowledge about emergence and transmission of AMR, and how this knowledge is used to inform interventions and evaluate them. The cycle is continuous because the evaluation process creates new knowledge and further inform intervention and so on.