Antimicrobial Resistance on Ships: A Narrative Review.

Antimicrobial resistance (AMR) poses a global health challenge, particularly in maritime environments where unique conditions foster its emergence and spread. Characterized by confined spaces, high population density, and extensive global mobility, ships create a setting ripe for the development and dissemination of resistant pathogens. This review aims to analyse the contributing factors, epidemiological challenges, mitigation strategies specific to AMR on ships and to propose future research directions, bridging a significant gap in the literature. Maritime environments facilitate the propagation of AMR through interconnected factors. The confined and communal nature of ships allows resistant pathogens to spread rapidly among diverse populations. The inappropriate and often empirical use of broad-spectrum antibiotics, compounded by limited access to diagnostic tools, accelerates the selection of resistant strains. Poor infection control practices, including inadequate sanitation and ineffective isolation measures, exacerbate the risks. Environmental contamination through untreated wastewater and ballast water discharge introduces resistant bacteria and genes into marine ecosystems, posing additional public health and ecological threats. Surveillance of AMR on ships is hampered by logistical barriers, including the lack of standardized protocols and reporting systems. Documented outbreaks of resistant pathogens, such as methicillin-resistant Staphylococcus aureus, underline the public health risks associated with AMR in maritime settings, alongside significant operational disruptions and environmental impacts. Despite advancements in portable diagnostic technologies, their adoption on ships remains minimal, leaving critical gaps in detection and management. Effective management of AMR in maritime settings necessitates the integration of stewardship programs tailored to shipboard environments, reinforced infection control measures, and advanced wastewater treatment.