Ecological and evolutionary mechanisms driving within-patient emergence of antimicrobial resistance

This review explores the ecological and evolutionary mechanisms of antimicrobial resistance (AMR) emergence in patients, focusing on four major mechanisms: spontaneous resistance mutations, in situ horizontal gene transfer, selection of pre-existing resistance, and immigration of resistant lineages. It suggests that understanding these mechanisms can be integrated into clinical trials of antimicrobials, enabling more predictive and personalized diagnosis and antimicrobial therapies.