Antimicrobial resistance (AMR) is a global health challenge that threatens humans, animals and the environment. Evidence is emerging for a role of healthcare infrastructure, environments and patient pathways in promoting and maintaining AMR via direct and indirect mechanisms. Advances in vaccination and monoclonal antibody therapies together with integrated surveillance, rapid diagnostics, targeted antimicrobial therapy and infection control measures offer opportunities to address healthcare-associated AMR risks more effectively. Additionally, innovations in artificial intelligence, data linkage and intelligent systems can be used to better predict and reduce AMR and improve healthcare resilience. In this Review, we examine the mechanisms by which healthcare functions as a driver, reservoir and amplifier of AMR, contextualized within a One Health framework. We also explore the opportunities and innovative solutions that can be used to combat AMR throughout the patient journey. We provide a perspective on the current evidence for the effectiveness of interventions designed to mitigate healthcare-associated AMR and promote healthcare resilience within high-income and resource-limited settings, as well as the challenges associated with their implementation.

抗菌素耐药性（AMR）是威胁人类、动物和环境的全球健康挑战。越来越多的证据表明，医疗保健基础设施、环境和患者途径通过直接和间接机制在促进和维持抗菌素耐药性方面发挥着作用。疫苗接种和单克隆抗体疗法的进步，加上综合监测、快速诊断、靶向抗菌治疗和感染控制措施，为更有效地应对医疗保健相关的 AMR 风险提供了机会。此外，人工智能、数据链接和智能系统的创新可用于更好地预测和降低抗菌素耐药性并提高医疗保健弹性。在这篇综述中，我们研究了医疗保健作为抗菌素耐药性的驱动因素、储存库和放大器的机制，并将其置于同一个健康框架的背景下。我们还探索可用于在整个患者治疗过程中对抗抗菌素耐药性的机会和创新解决方案。我们对旨在减轻与医疗保健相关的抗菌素耐药性和提高高收入和资源有限环境中的医疗保健复原力的干预措施的有效性的当前证据以及与实施相关的挑战提供了视角。