Veterinary apramycin resistance spreads to humans via food chains, study finds
image: (a) Stacked bar chart for the number of samples collected from various sampling sites in three cities. The colors of the bars represent different sample types, with dark and light shades indicating samples positive and negative for AREC, respectively. (b) The distribution of AREC isolates across diverse sampling sites and sample types.
Credit: Yue Cao, Dejun Liu, Fen Pan, Zhenzhen Liu, Qin Zhang, Chengtao Sun, Li Ding, Siquan Shen, Weishuai Zhai, Rina Bai, Zhiyu Zou, Yiqing Wang, Lu Yang, Zexun Lv, Bo Fu, Shizhen Ma, Yao Wang, Ke Zhao, Tingxuan Shi, Yingbo Shen, Rong Zhang, Timothy R. Walsh, Jianzhong Shen, Fupin Hu, Yang Wang, Congming Wu
A multicenter One Health research published in Engineering maps the cross-sector circulation of apramycin-resistant Escherichia coli (AREC) across animal production and human populations in China, revealing plasmid-driven resistance transmission risks ahead of apramycin’s potential clinical use for humans.
Apramycin is an aminoglycoside antibiotic exclusively deployed in veterinary practice, with promising therapeutic prospects against multidrug-resistant Gram-negative pathogens supported by two completed Phase I human clinical trials. Its resistance dynamics across interconnected human-animal-environment interfaces remain insufficiently documented before this cross-sectional study conducted between 2020 and 2023 in Chengdu, Qingdao and Shanghai. Researchers gathered 5160 non-duplicate specimens covering clinical patient samples, human fecal specimens from outpatient and physical examination populations, pig and broiler farm feces, carcasses, market fresh meat, and farm environmental swabs, recovering 1394 AREC isolates from all sampling matrices. The aac(3)-IV gene, which mediates concurrent resistance to apramycin, gentamicin and tobramycin, was detected in 1390 of these isolates, accounting for 99.7% of all AREC strains recovered.
Genomic sequencing work incorporated short-read whole-genome sequencing for 742 representative AREC isolates and long-read Nanopore sequencing for 66 strains covering distinct geographic regions and sample origins. Single-nucleotide polymorphism comparison with a 25-SNP threshold confirmed sporadic clonal transmission events bridging animal production chains and human hosts in Qingdao and Shanghai, while frequent homologous strain exchange occurred within pig and broiler production pipelines across all three surveyed cities. Three conserved genomic backbones supported the stable carriage of aac(3)-IV, designated type A, B and C, which were recovered uniformly from human infection, human carriage, livestock farm, slaughterhouse and retail meat samples. Long-read plasmid assembly verified that aac(3)-IV predominantly resides on IncHI2/IncHI2A plasmids, which constituted 62% of all resistance-bearing plasmids characterized and were widely distributed across all sample sources. Multiple high-similarity plasmid networks were identified via Mash distance evaluation, proving the same IncHI2/IncHI2A plasmid scaffolds circulate between livestock, retail meat and human carriers.
Temporal genomic surveillance spanning five decades further recorded a statistically significant upward trend in aac(3)-IV prevalence among livestock E. coli after apramycin received official veterinary approval in China in 2000, aligning with consistent annual growth in national apramycin consumption up to 2019. The study notes that cross-resistance induced by aac(3)-IV means gentamicin and tobramycin used in clinical wards can maintain selective pressure for apramycin-resistant strains even if apramycin use in farming is restricted. The research team states that the extensive prevalence of AREC in animal production sectors and mobile plasmid-mediated gene transfer call for prudent veterinary antimicrobial stewardship and cautious evaluation of apramycin’s repurposing for human clinical care, alongside systematic integration of apramycin resistance monitoring into national antimicrobial resistance surveillance frameworks. The paper acknowledges limitations including limited community population fecal sampling and incomplete clinical metadata for human isolates, which restricts deeper analysis of clinical resistance drivers.
The paper “Distribution and Transmission of Apramycin-Resistant Escherichia coli from Humans and Animal-Producing Sectors: A Multicenter, Cross-Sectional, and One Health Study,” is authored by Yue Cao, Dejun Liu, Fen Pan, Zhenzhen Liu, Qin Zhang, Chengtao Sun, Li Ding, Siquan Shen, Weishuai Zhai, Rina Bai, Zhiyu Zou, Yiqing Wang, Lu Yang, Zexun Lv, Bo Fu, Shizhen Ma, Yao Wang, Ke Zhao, Tingxuan Shi, Yingbo Shen, Rong Zhang, Timothy R. Walsh, Jianzhong Shen, Fupin Hu, Yang Wang, Congming Wu. Full text of the open access paper: https://doi.org/10.1016/j.eng.2025.11.035. For more information about Engineering, visit the website at https://www.sciencedirect.com/journal/engineering.