Climate change accelerates antimicrobial resistance - One Health must become the operating system

Antimicrobial resistance (AMR) and climate change are increasingly recognized as interconnected global threats driven by shared ecological, infrastructural, and socioeconomic vulnerabilities. This review summarizes emerging mechanistic and epidemiological evidence demonstrating how rising temperatures, hydrological extremes, ecosystem disruption, and environmental pollution accelerate the selection, persistence, and spread of antimicrobial resistance genes at the human-animal-environment interface. We emphasize climate-sensitive pathways, such as heat-driven microbial evolution, hydrological mobilization of resistance factors, aerosolized transmission, and climate-stressed food systems, which collectively reshape the distribution and impact of resistant bacterial infections. Importantly, we identify practical, co-beneficial interventions including pollution control, climate-resilient water and sanitation systems, adaptive antimicrobial stewardship, AI-powered surveillance, and integrated One Health governance. Framing AMR as a climate-sensitive health outcome shifts it from a mostly reactive, downstream clinical challenge to a predictable, preventable upstream systems vulnerability influenced by climate dynamics. Incorporating climate awareness into AMR policies and actions is therefore vital to preserving antimicrobial effectiveness, bolstering health system resilience, and safeguarding climate-sensitive populations in a rapidly warming world.