Climate change and antimicrobial resistance (AMR) are two of the most pressing global challenges, with emerging evidence suggesting they are interconnected in natural aquatic systems. Rising temperatures, altered precipitation patterns, and increased frequency of extreme weather events influence the distribution, abundance, and persistence of microbial communities in freshwater, estuarine, and marine ecosystems. These environmental changes can accelerate horizontal gene transfer, promote selection for resistant strains, and enhance the proliferation and dissemination of antimicrobial resistance genes (ARGs) in aquatic environments. Anthropogenic pressures, including wastewater discharge, agricultural runoff, and aquaculture practices, further exacerbate the spread of AMR under climate-driven stress. This review synthesizes current understanding of the mechanisms linking climate change and AMR, highlighting how temperature shifts, salinity changes, nutrient fluxes, and hydrological disturbances modulate microbial ecology and resistance dynamics. We examine ecological consequences for microbial communities, potential human health risks through waterborne exposure, and implications for ecosystem services. Finally, we discuss monitoring strategies, mitigation approaches, and policy interventions necessary to address the dual threats of climate change and AMR. Understanding these emerging interactions is critical for developing integrative environmental and public health strategies that safeguard both aquatic ecosystems and human populations from the synergistic effects of global environmental change.
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