Antimicrobial resistance in poultry meat in the mediterranean region: prevalence, public health implications, and control strategies: A review.

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Learn more: PMC Disclaimer | PMC Copyright Notice Poult Sci . 2026 May 12;105(8):107096. doi: 10.1016/j.psj.2026.107096 Antimicrobial resistance in poultry meat in the mediterranean region: prevalence, public health implications, and control strategies: A review Amal Mayyas a, 1 , Hamzah M Al-Qadiri b, 1, ⁎ , Murad A Al-Holy c , Amin N Olaimat c , Aseel AbuAlshaar d , Islam Hamad a , Rula A Amr e , Ali Al-Samydai f , Hussein Al-Maharmeh g , Zeinab MH Mahasneh h, i, ⁎ Author information Article notes Copyright and License information a Department of Pharmacy, Faculty of Health Sciences, American University of Madaba, Madaba, 11821, Jordan b Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, 11942 Jordan c Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan d Department of Biology and Biotechnology, Faculty of Science, American University of Madaba, Madaba, 11821, Jordan e Department of Nutrition and Health Psychology, Faculty of Health Sciences, American University of Madaba, Madaba, Jordan f Pharmacological and Diagnostic research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, 19328 Jordan g Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan; h Department of Animal Production and Protection, Faculty of Agriculture, Jerash University, Jerash, 26150, Jordan i Department of Animal Production, School of Agriculture, The University of Jordan, Amman, 11942, Jordan ⁎ Corresponding authors. h.qadiri@ju.edu.jo z_mahasneh@ju.edu.jo Z.mahasneh@jpu.edu.jo 1 These two authors contributed equally to this work and share first authorship. Received 2026 Mar 11; Accepted 2026 May 6; Collection date 2026 Aug. © 2026 The Authors This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). PMC Copyright notice PMCID: PMC13223857  PMID: 42184743 Abstract Antimicrobial resistance (AMR) is considered one of the major threats to public health in the 21st century, and the role of animal-derived foods in the development and spread of resistant bacteria is now globally recognized. Poultry meat, as the most-consumed source of animal protein worldwide, has been consistently associated with the carriage of multidrug-resistant (MDR) bacteria across several foodborne pathogens. The excessive and misuse of antimicrobials for therapeutic, prophylactic, and growth-promoting purposes in the poultry sector have accelerated the development of antibiotic resistance, which may contribute to human exposure through the food chain. Recent investigations have documented the presence of extended-spectrum β-lactamase (ESBL)-producing bacteria and mcr-1 -associated colistin-resistant strains in broiler meat, highlighting a potential public health concern regarding AMR transmission through the food chain. The continued emergence and dissemination of zoonotic pathogens constitute a critical global health challenge; accordingly, mitigating these risks to human, animal, and environmental health necessitates the execution of a comprehensive One Health framework. Despite multiple national surveillance initiatives, substantial gaps continue in the comparative assessment of AMR trends, policy heterogeneity, and the degree of One Health integration across Mediterranean countries. This review intends to address these deficiencies by synthesizing current evidence on AMR in poultry meat, with particular emphasis on the Mediterranean region, and by critically evaluating intervention measures to reduce associated human health risks. Keywords: Antimicrobial resistance, Extended-spectrum β-lactamase, Resistance genes, Multidrug-resistant, Poultry meat Introduction Antimicrobial resistance (AMR) has emerged as one of the most persistent global health challenges ( Al-Qadiri et al., 2025 ; Mayyas, et al., 2025 ; Tang, et al., 2023 ). The World Health Organization (WHO) highlighted humanity's urgent need to avoid antimicrobial resistance, which could once again make common infections lethal ( World Health Organization, 2023 ). The burden of AMR is already substantial: 1.27 million deaths during 2019 were directly attributed to drug-resistant infections, and nearly 5 million deaths were associated with resistant bacteria ( Murray, et al., 2022 ). While the AMR issue is linked to multiple environmental and clinical factors, one of the most growing threats is the use of antimicrobials in food-animal production, particularly in poultry ( Shoaib, et al., 2025 ). Poultry meat represents the most extensively consumed source of animal-derived protein globally ( Mottet and Tempio, 2017 ). According to the Food and Agriculture Organization of the United Nations (FAO), global poultry meat production reached 136.1 million metric tons in 2020, with consumption demonstrating stable growth across both developed and developing regions ( FAO, 2023 ). Chicken meat is frequently preferred because it is relatively inexpensive, widely available, and culturally accepted across diverse populations. However, intensive poultry farming systems, which dominate global production, are strongly dependent on antibiotics for growth promotion, prophylaxis, and therapy ( Haque, et al., 2020 ; Salim, et al., 2018 ; Zheng, et al., 2025 ). Such reliance creates conditions for the selection and spread of foodborne-resistant bacteria, in particular Salmonella spp ., Campylobacter spp ., Staphylococcus aureus, Listeria monocytogenes , and commensal Escherichia coli , which can serve as reservoirs of transferable resistance genes ( Rafiq, et al., 2024 ; Slader, et al., 2002 ). European Food Safety Authority (EFSA) reported that campylobacteriosis and salmonellosis are the most frequently occurring human foodborne diseases linked to poultry ( Żbikowska, et al., 2020 ). The use of antibiotics in poultry farming and industry began in the 1940s, when low doses of antimicrobials were found to promote growth and boost feed efficiency. In 1951, the U.S. Food and Drug Administration (US FDA) approved antibiotics for use without a veterinary prescription. Routine use of Antibiotic growth promoters (AGPs) in poultry diets has spread across North America and Europe ( Rafiq, et al., 2024 ). For decades, this practice has been reported to be an economically efficient means of meeting the rising demand for affordable animal protein. However, scientific evidence linking AGPs to the development of resistant bacteria that can spread to humans started in 1969 ( Barton, 2000 ; Jan, et al., 2025 ). The accumulation of antibiotics and their residues in body tissues reflects prior antimicrobial exposure and patterns of antimicrobial use ( Kurćubić, et al., 2025 ). Given deepening concerns, the European Union (EU) took decisive regulatory steps by banning the use of avoparcin, a glycopeptide antibiotic related to vancomycin, in 1997 ( European Commission, 1997 ), followed by a complete ban on its use as a growth promoter, which took effect in 2006 ( European Commission, 2003 ). Other countries, including the United States, moved slowly but eventually implemented both voluntary and mandatory restrictions on the use of vital medical antimicrobials in food-producing animals. ( US.FDA, 2017 ). The WHO further endorsed guidelines in 2017, recommending an end to the unrestricted use of antibiotics as growth promoters and for disease prevention in food animals ( World Health Organization, 2017 ). In several low- and middle-income countries (LMICs), the use of antibiotics in poultry farming continues despite global policy restrictions. The absence of effective regulations and guidelines, and the lack of regulatory supervision of veterinary services, have led to the improper use of antibiotics in poultry farming ( Zheng, et al., 2025 ). However, across Mediterranean countries, high rates of nonprescription antibiotic use and rapid growth in poultry meat demand have been reported, which may progressively increase the burden of antimicrobial resistance ( Abraham, et al., 2025 ; Mestrovic, et al., 2025 ). For the purposes of this review, the Mediterranean region was defined using an integrated geographical and epidemiological framework. Accordingly, the analysis encompassed Mediterranean countries in Southern Europe, North Africa, and the Eastern Mediterranean ( Fig. 1 ), including both European Union and non-European nations, which are interconnected through shared food production systems, trade networks, and antimicrobial use practices. This approach aligns with previous antimicrobial resistance surveillance frameworks that assess prevalence based on regional interconnectedness rather than strictly on geographical boundaries, as demonstrated in recent WHO regional reports and global AMR surveillance data ( Mestrovic, et al., 2025 ; Tosas Auguet, et al., 2025 ; World Health Organization, 2024 ). Figure 1. Open in a new tab Comparative prevalence and distribution of Campylobacter spp. (●), Salmonella spp. (■), and E. coli (including ESBL-producing strains) (▲) in poultry meat across the Mediterranean region. Data are representative of Algeria, Egypt, France, Greece, Italy, Jordan, Lebanon, Morocco, Spain, Tunisia, and Türkiye. E. coli data reflect total commensal isolates across all regions; however, where reported (Algeria, Egypt, Italy, Lebanon, Morocco, and Tunisia), prevalence specifically refers to ESBL-producing strains. Prevalence ranges and specific "n" values for each country are based on peer-reviewed surveillance data and recently published official national reports. Base map adapted from ( Boulajfene, 2024 ) . Several studies have shown that poultry meat could be considered a potential source of AMR bacteria to humans, which are among the leading causes of foodborne illness worldwide and are commonly linked to poultry ( Di Taranto, et al., 2025 ; Nobile, et al., 2013 ). Non-pathogenic commensal E. coli strains found in poultry meat act as reservoirs for extended-spectrum β-lactamase (ESBL) genes, possibly facilitating the horizontal gene transfer of these determinants to other pathogens ( Abraham, et al., 2025 ; Al-Qadiri, et al., 2025 ). A particular example of emerging resistance to antibiotics, the plasmid-mediated colistin resistance gene mcr-1 , was first reported in 2015 in poultry meat, where it reduced the effectiveness of colistin, a reserve antibiotic used for MDR infections ( Aklilu and Raman, 2020 ). The Mediterranean region, including European Union (EU) member states and North African and Middle Eastern countries outside the EU, provides a unique case study of AMR in poultry ( European Food Safety Authority, 2025 ). Countries in this area differ considerably in their agricultural practices, regulations, and enforcement capabilities ( Faour-Klingbeil and Todd, 2018 ). Southern European nations like Spain, Greece, and Italy still report a high prevalence of AMR bacteria in retail poultry meat, in spite of robust EU monitoring systems ( García-Béjar, et al., 2021 ; Ghodousi, et al., 2015 ). Nevertheless, North, West, and East African countries face more challenges with regulatory enforcement, and studies have documented the broad presence of ESBL-producing E. coli and MDR Salmonella spp. in retail chicken meat ( Ayinla and Mateus, 2023 ; Langata, et al., 2019 ). Poultry farming is vital to the food supply and economy of LMICs in the Eastern Mediterranean; however, recent studies have revealed a high prevalence of foodborne pathogens resistant to antimicrobials. For example, Salmonella spp. isolated from retail chicken meat, have been found to carry MDR phenotypes ( Al-Qadiri, et al., 2025 ; Rahman, et al., 2024 ), while C. jejuni isolates show resistance to fluoroquinolones and macrolides ( Mayyas, et al., 2025 ; Shami, et al., 2024 ), and the detection of E. coli in broiler chickens is particularly alarming ( Gharaibeh, et al., 2024a ; Ibrahim, et al., 2019 ). These findings stress the urgent need to enhance AMR control and regulation, and to adopt WHO One Health surveillance to cover the entire food production process. The global poultry industry has been persistently linked to the dissemination of AMR bacteria. Multiple studies from surveillance programs, systematic reviews, and meta-analyses have confirmed that raw chicken meat is a significant source of resistant Salmonella spp., Campylobacter spp., and E. coli ( Indrajith, et al., 2015 ; Sajish, et al., 2025 ). Systematic reviews consistently identify poultry meat as the primary reservoir of resistant bacteria among food-producing animals. Sodagari, et al. (2015) reported a high prevalence of Salmonella spp. in retail poultry meat worldwide, while Myintzaw, et al. (2023) highlighted that Campylobacter spp. infections associated with poultry are among the leading foodborne zoonoses. Bradford (2001) reported that resistance determinants are encoded by genes located on plasmids or chromosomes of Enterobacteriaceae , with the highest prevalence in developing countries. However, Barilli, et al. (2020) reported that approximately 25% of E. coli isolates from meat products formed biofilms and that 40% of E. coli isolates from retail chicken meat in Europe are ESBL producers, thereby significantly increasing the risk of resistance gene transmission to humans ( Damianos, et al., 2025 ; Que, et al., 2025 ). Prevalence rates vary considerably across areas, implying challenges with farming practices, uncontrolled antimicrobial use, poor hygiene standards, and deficient regulatory oversight ( Al-Qadiri, et al., 2025 ; Mayyas, et al., 2025 ). High resistance rates were observed to tetracycline, ciprofloxacin, streptomycin, and ampicillin. Several research works have confirmed the presence of resistance genes underlying the observed phenotypic resistance patterns ( Al-Qadiri, et al., 2025 ; Erfan and Marouf, 2015 ; Indu Sharma and Kashmiri Das, 2016 ; Mayyas, et al., 2025 ). According to these studies, the presence of antibiotic resistance genes (ARGs) bla, tet, aph , and sul gyr was confirmed among the isolated strains that showed resistance to β-lactam cephalosporines, tetracycline, aminoglycosides, sulphonamides, and fluoroquinolones ( Erfan and Marouf, 2015 ; Indu Sharma and Kashmiri Das, 2016 ; Soufi, et al., 2011 ). Overall, global evidence indicates that AMR bacteria in poultry meat are widespread, although prevalence varies by region ( Abou-Jaoudeh, et al., 2024 ). High-income countries with strict regulations (parts of the EU) report lower rates of certain resistance types. Meanwhile, LMICs in Asia, Africa, and Latin America tend to have higher levels of antimicrobial resistance due to unregulated antimicrobial use and ineffective biosecurity measures ( Elbehiry and Marzouk, 2025 ). Importantly, resistant pathogens from poultry are not confined to local areas; international trade in poultry meat may significantly contribute to their spread worldwide ( Izah, et al., 2025 ). Given the global significance of AMR, this review aims to: – Systematically assess the prevalence and characterize the antimicrobial resistance profiles of Salmonella spp., E. coli, and Campylobacter spp. within the poultry meat production sector across selected Mediterranean countries. – Conduct a comparative analysis of AMR trends across different regions of the Mediterranean basin to explain geographical variability and potential epidemiological linkages. – Critically assess the public health implications of AMR pathogens originating from poultry production. – Identify critical policy gaps and develop evidence-based strategies to strengthen the WHO’s One Health framework and advance antibiotic stewardship in poultry production systems. Geographical prevalence of bacterial pathogens and AMR in poultry farming The Mediterranean basin includes a wide variety of countries across southern Europe, North Africa, and the Middle East ( Defaye, et al., 2022 ). This region is unique because it comprises high-income EU member states that may have strict regulatory oversight. Whereas LMICs have weaker veterinary oversight and enforcement of antimicrobial use regulations ( Moodley, 2025 ). The poultry production continuum in the Mediterranean region represents a critical interface for the transmission of zoonotic pathogens, with Campylobacter spp. and Salmonella spp. remaining the primary drivers of foodborne morbidity. Recent surveillance data presented in Figure 1 reveal a high degree of diversity in the prevalence of indicator E. coli, Campylobacter spp., and Salmonella spp. across the Mediterranean basin. For E. coli , prevalence ranges from approximately 30% in France to over 90% in Türkiye and Morocco, with a significant portion of isolates, particularly in North Africa and the Levant, exhibiting ESBL-producing phenotypes ( Amzil, et al., 2025 ; Dilio, et al., 2025 ). Similarly, Campylobacter contamination remains pervasive, ranging from 19% to 49% in nations like Spain and France( Bort, et al., 2022 ; News, 2025 ), yet peaking as high as 70% to 90% in Greece and Türkiye, highlighting a persistent challenge in mitigating contamination during the slaughtering and scalding processes ( Cakmak and Erol, 2012 ; Kostoglou, et al., 2023 ). A similarly heterogeneous pattern is observed for Salmonella ; while countries such as France report relatively low retail contamination rates (0.9%−7.5%) supported by effective National Control Programs ( Huneau‐Salaün, et al., 2025 ), Italy exhibits a much broader range (7.5%–32.6%), with elevated levels often localized to southern territories or specific meat preparations ( Di Taranto, et al., 2025 ; R. Roila1, 2023 ). This regional disparity further widens in Anatolia and North Africa, where retail burdens for these pathogens in countries such as Türkiye and Egypt frequently exceed 35% and 80%, respectively ( Çufaoğlu, et al., 2023 ; Melly, et al., 2008 ; Rashwan, et al., 2025 ). A major public health concern identified in this multi-regional assessment is the high prevalence of E. coli harboring ESBL- and AmpC-producing phenotypes. The data indicate a "farm-to-fork" resistance gradient, where fecal and environmental reservoirs at the farm level show nearly universal commensal E. coli presence, often exceeding 80% in countries like Algeria and Tunisia ( Dilio, et al., 2025 ; Messaoudene, et al., 2025 ). Of particular note is the high recovery rate of ESBL-producing strains from retail meat in Morocco (83.5%) and Lebanon (38.7%), which underscores the role of poultry meat as a significant vehicle for the dissemination of MDR genes into the human food chain ( Amzil, et al., 2025 ; Dandachi, et al., 2018 ). This widespread resistance to third-generation cephalosporins (ESC) and fluoroquinolones poses a direct threat to clinical treatment efficacy for human enteric infections. The distribution dynamics across the production chain reveal that organ tissues and environmental samples often harbor more diverse AMR profiles than processed retail meat. In Jordan and Egypt, for instance, high isolation rates of pathogenic and indicator E. coli in liver and gizzard samples (reaching up to 94%) suggest that internal organs may act as concentrated reservoirs for resistant isolates ( Gharaibeh, et al., 2024b ). This phenomenon is frequently linked to "informal" or traditional slaughtering practices, such as the "Natafat" system in the Levant, where cross-contamination between fecal matter and carcasses is more frequent than in industrial EU-standard facilities ( Al-Qadiri, et al., 2025 ). Accordingly, the presence of highly resistant E. coli and zoonotic pathogens along the Mediterranean poultry value chains necessitates a harmonized "One Health" surveillance strategy. The integration of phenotypic profiling and prevalence data indicates that while retail meat is the final point of exposure, the environmental and fecal contamination at the farm level remains the root source of the AMR burden ( European Food Safety Authority, 2025 ). Future interventions must prioritize biosecurity at the farm level and hygiene standardization in traditional retail markets to curb the regional spread of ESBL/AmpC-producing organisms and ensure the safety of the Mediterranean poultry trade. As a result, the prevalence of AMR in poultry meat across the Mediterranean varies but remains concerning ( Alvarez, et al., 2020 ; Xing, et al., 2025 ). The evidence reviewed indicates that chicken meat is a key vector for the global spread of AMR bacteria. Resistant Salmonella, Campylobacter , and E. coli are consistently detected in poultry products, with prevalence varying by region. Despite stringent regulatory measures and antimicrobial stewardship programs, middle-income countries in the Eastern Mediterranean and the Middle East continue to face substantial challenges related to AMR and food production systems ( Harb, et al., 2019 ). Tables 1 , 2 , and 3 describe the available evidence, summarizing the prevalence of AMR across the Mediterranean region and highlighting the widespread distribution and variability of resistant pathogens across countries and poultry production systems. It should be noted that the reported AMR rates are derived from heterogeneous sample types, including feces, environmental samples, organs/tissues, and chicken meat. Accordingly, direct comparisons of prevalence estimates across countries and studies should be interpreted with caution, as observed differences may partly reflect variation in sampling matrices rather than true underlying epidemiological variability. Table 1. Prevalence and characterization of indicator E. coli , AMR profiles, MDR, and ESBL/ AmpC phenotypes along the poultry production continuum in the Mediterranean region: fecal, environmental, and organ/tissue samples vs. retail meat. Country Sample source E. coli prevalence AMR/ MDR ESBL and/or AmpC % Reference Feces Environmental Organs/ tissues Chicken meat Jordan Visceral organs of sick chickens (53.4%) Amoxicillin (93.3%), doxycycline and spectinomycin (92.2%), oxytetracycline (55%), and gentamicin (57.2%) Not reported ( Ibrahim, et al., 2019 ) Lebanon Fecal samples from healthy broiler/Farm level (87%) ESC-resistant isolates MDR (100%) among the ESC-resistant Enterobacterales isolates. ESBL (71%), AmpC (11%), or both phenotypes ( Mikhayel, et al., 2021 ) Egypt Lungs and trachea/ Broiler poultry farms (56%) MDR (100%) among isolated E. coli. Serogroups of isolated E. coli (65.7%). ( Ali, et al., 2023 ) Tunisia Caecum content of healthy chicken (97.3%) MDR (98%). ESBL-producing isolates (70%). ( Nsibi, et al., 2025 ) Morocco Intestinal samples of market-age broilers (83.5%) MDR (64%) in 2017, MDR (93%) in 2019. ESBL (10.32%). ( Amzil, et al., 2025 ) Italy Broiler neck skin at slaughter (95.5%) Ampicillin (73.8%), sulfonamides (72.5%), fluoroquinolones, nalidixic acid (62.5%), and ciprofloxacin, (67.5%) ESBL-AmpC-Positive isolates (37.9%). ( Dilio, et al., 2025 ) Greece Fecal samples from broilers and laying hens Not reported Sulfamethoxazole (81.1%), nalidixic acid (73.6%), tetracycline (70.8%), and streptomycin (70.8%). ESBL-producing isolates: broiler (13.6%), Laying hens (10.2%). AmpC β-lactamase: boiler (2.7%) and lying hens (1%) ( Xexaki, et al., 2023 ) France Retail chicken meat (drumsticks) (91.7%) ESC-resistant E. coli High co-resistance to sulfonamides ( 84.4%) , tetracyclines ( 75.3%) , trimethoprim (51.9%) , quinolones (41.6%) , aminoglycosides ( 29.9%) , phenicols ( 14.3%) , fluoroquinolones ( 20.8%) ESBL phenotype (96.1%), AmpC (3.9%), bla CTX-M-1 dominant (91.9%) ( Casella, et al., 2017 ) Spain Environmental samples (manure and air) of a broiler farm Not reported MDR (46.8%) ESBL (20.7%) ( Martínez-Álvarez, et al., 2022 ) Turkey Chicken faeces samples Not reported Not reported ESBL (28.6%) ( Sipahi and Cevik, 2025 ) Syria Chicken meat 72.9% E. coli isolation from arthritis joints) Not reported Not reported ( ALKARAWANI and KURDI, 2013 ) Open in a new tab Prevalence values represent sample-level occurrence, isolation/recovery rates, or proportions among recovered isolates as defined in the primary literature. ‘Indicator E. coli ’ denotes non-targeted isolates; however, specific studies may include clinical or pathogenic strains as reported. ESC: extended-spectrum cephalosporins. Table 2. Prevalence, AMR profiles, and MDR phenotypes/genotypes of Campylobacter spp. along the poultry production continuum in the Mediterranean region: fecal, environmental, swabs, and organ/tissue samples vs. retail meat. Country Sample source Campylobacter spp. prevalence AMR/ MDR Reference Feces Environmental, cloacal, and carcass swabs Organs/ tissues chicken meat Jordan Chicken meat (fresh, refrigerated, frozen) Overall: (31.6%), fresh: (59.3%), refrigerated: (35.6%), frozen: (0%), Species: C. coli (64%), C. jejuni (36%) MDR (100%) of isolates ; ciprofloxacin ( 100%) resistance , imipenem ( 100%) susceptibility Alaboudi, et al., 2020; Mayyas, et al., 2025 ) Lebanon Fecal samples (88%) Not reported ( Awada, et al., 2023 ) Egypt Pooled cloacal swab samples were derived from broilers and layers C. jejuni : (12%), C. coli : (1.9%) MDR: Not reported. tetO (75%) in broilers and layers, blaOXA-61 (50%) in broilers, and ( 12.5%) in layers, gyrA (37.5%), cmeB (25%) ( Shaheed, et al., 2025 ) Tunisia Cloacal swab/ broiler flocks (22.4%) with predominance of C. jejuni (68.9%), followed by C. coli 31.1% MDR (100%) ( Gharbi, et al., 2018 ) Morocco Caecum, neck skin, and breast muscle: samples were collected from slaughterhouses and traditional markets Overall (28.7%), retail markets: (41.33%), slaughterhouses: (19.85%), predominance of C. coli : (84%), followed by C. jejuni : (16%) MDR (68%) ( Soubai, et al., 2025 ) Italy Broiler farms (cloacal) Broiler skin at slaughter C. jejuni: ( 32.3%), C. coli : ( 23.9%) Not reported ( Iannetti, et al., 2020 ) Greece Backyard/free-grazing chicken tissues from rural households C. jejuni : (38.3%), C. coli : (25.0%) MDR (71.62%) ( Dermatas, et al., 2024 ) France Broiler chickens (cecal samples at slaughterhouses) C. jejuni : 544 isolates, C. coli : 374 isolates Ciprofloxacin resistance: C. jejuni (19.5%), C. coli (37.4%). Erythromycin resistance: C. jejuni (1.8%), C. coli (21.1%), and high tetracycline resistance ( Gallay, et al., 2007 ) Spain Broiler fecal droppings Broiler meat (35.4%) in meat, and (62%) in feces. Among all isolates, C. C. jejuni : 55 isolates, C. coli : 31 isolates MDR (40.7%). Ciprofloxacin (86.5%), tetracycline (85.4%), and erythromycin (49.4%) ( Nafarrate, et al., 2021 ) Turkey Broiler meat isolates (within mixed human-animal dataset) Not reported Quinolone resistance (43.75%). All resistant isolates carried the gyrA Thr-86-Ile mutation ( Aydin, et al., 2023 ) Syria Skin and liver swabs Breast muscle (46%) in skin swabs, (34%) in liver swabs, and (20.7%) in breast muscle samples. Not reported ( Melly, et al., 2008 ) Open in a new tab Prevalence values represent sample-level occurrence, isolation/recovery rates, or proportions among recovered isolates, including resistance genotypes, as defined in the primary literature. Table 3. Prevalence, AMR profiles, MDR, and ESBL patterns of Salmonella spp. along the poultry production continuum in the Mediterranean region: environmental, fecal, swabs, organ/tissue, and retail meat samples. Country Sample source Salmonella spp. prevalence AMR/ MDR ESBL Reference Live animal/clinical source Environmental, cloacal, fecal, and carcass swabs Organs /tissues Chicken meat Jordan Chilled raw chicken meat (15.47%) (41.5%) Not reported ( Al-Qadiri, et al., 2025 ) Breeder drag swabs Chicken meat Overall: (15.47%), ( 3%) in breeder drag swabs, and ( 53.3%) in final chicken meat MDR common. Resistance to ciprofloxacin (91%), nalidixic acid (86.5%), doxycycline (83.1%), tetracycline (83.1%), co-trimoxazole (79.8%), and ampicillin (76.4%). blaTEM detected in (88.8%) of isolates, blaSHV and blaCTX-M each (2.2%), blaCMY (7.9%), and blaOXA (0%) ( Gharaibeh et al., 2024c ) Lebanon Retail chicken carcasses (18.05%) (57.69 %) ESBL (34.61%) ( Khalife and El Safadi, 2024 ) Egypt Broiler chicks from poultry farms and diagnostic labs (6.44%) MDR: (24.1%), XDR: (75.49%) blaTEM (82.8%), blaCTX-M (24.1%), blaSHV (24.1%), and blaCMY-2 (10.3%) ( Salem, et al., 2025 ) Tunisia Broiler meat samples (neck skin) Broiler meat samples (breast muscle, and cutting parts) Neck skin (11.8%), breast muscle (0.9%), and cutting parts (5.1%) MDR (90.5%) ESBL (12.2%), blaCTX-M detected in all ESBL strains ( Oueslati, et al., 2022 ) Morocco Retail chicken meat (12.66%) MDR (42.1%), Resistance to ≥1 antibiotic (65.78%). Resistance to tetracycline (50%), nalidixic acid (50%), ampicillin (39.47%), streptomycin (34.21%), sulphonamides (31.57%), and ciprofloxacin (26.31%) ESBL (2.63%) ( Khallaf, et al., 2014 ) Italy Chicken food samples from retail and official control (fresh meat, MSM, meat preparations, and cooked products) (32.55%) MDR (87.5%). Resistance to ciprofloxacin (95.31%), nalidixic acid (92.97%), tetracycline (82.03) %, sulfamethoxazole (86.72%), trimethoprim (74.22%), and ampicillin (41.41%) (12.5%) ESBL ( Di Taranto, et al., 2025 ) Greece Skin Broiler chicken carcasses (neck-skin samples) (37%) Very high resistance (100%) to penicillin, erythromycin, vancomycin, and clindamycin. > 90% resistance to tetracycline, oxytetracycline, and streptomycin Not reported ( Sakaridis, et al., 2011 ) France Commercial broiler chicken flocks at the end of the rearing period (fecal litter swabs) (8.6%) Not Reported Not reported ( Le Bouquin, et al., 2010 ) Spain poultry production (broilers, turkeys, and layers) Not reported MDR mean: turkeys (80%), broilers (40%), and layers (≤14%). Resistance to ≥1 antibiotic: broilers (93-97%), turkeys (97-100%), and layers (50-69%) Not reported ( Cortés et al., 2022 ) Turkey Broiler litter (22%) MDR (93.5%). Resistance to penicillin ( 100%), and lincomycin ( 93.5%) (58.7%) ( Ozturk, 2022 ) Syria Not reported Not reported Not reported Not reported Open in a new tab Prevalence values represent sample-level occurrence, isolation/recovery rates, or proportions among recovered isolates, including resistance genotypes, as defined in the primary literature. In developing countries, regulatory oversight of antibiotic use in agriculture remains variable, which may contribute to the selection and dissemination of antimicrobial-resistant bacterial strains ( Abou-Jaoudeh, et al., 2024 ). Consistent with this, AMR prevalences reported in several developing countries may, in general, exceed those observed in France, Greece, and Italy. African Mediterranean countries may face unique challenges, as poultry production primarily occurs on small-scale farms with limited veterinary surveillance and supervision ( Nassar and Stino, 2013 ). North African nations such as Egypt, Tunisia, and Morocco are major poultry producers; however, their regulatory systems are less developed than those in Europe ( Moreki, et al., 2025 ). Studies consistently show a high prevalence of resistant bacteria in retail chicken meat, often exceeding levels seen in southern Europe. In Egypt, Ahmed, et al. (2023) reported that 34% of chicken breast isolates were E. coli -positive, with 58.8% ESBL-positive. A recent study also reported the widespread occurrence of virulence and resistance genes in E. coli isolates from chicken parts sold in retail outlets in Cairo ( Ahmed, et al., 2025b ). Similarly, Salem, et al. (2023) reported ESBL-producing E. coli in chickens from El-Sharkia governorate, with a high rate of resistance to β-lactams and aminoglycosides. Tunisia has reported widespread AMR in poultry. Hmidi, et al. (2025) observed that 38% of chicken meat samples contained ESBL-producing E. coli , with frequent detection of CTX-M and CMY-2 genes. Abdallah, et al. (2025) noted that the prevalence of ESBL E. coli in Tunisian poultry meat can reach 63.8%, indicating a significant public health concern. In Morocco, although the literature is somewhat limited, Khallaf, et al. (2014) found that Salmonella spp. was common in retail chicken meat sold in Rabat, with many isolates resistant to key antimicrobials such as ampicillin and tetracycline. These findings indicate that, despite assorted poultry production sizes, North African countries share a common challenge: elevated antimicrobial resistance resulting from unregulated antimicrobial use ( Oueslati, et al., 2021 ; Panyako, et al., 2022 ). The Levant region, comprising Lebanon, Syria, the West Bank, and Jordan, has attracted growing focus recently due to increasing evidence of AMR linked to poultry farming ( Abukhattab, et al., 2023 ; Al-Qadiri, et al., 2025 ; Mayyas, et al., 2025 ). In Lebanon, Khalife and El Safadi (2024) studied raw poultry meat and detected Salmonella in 18.05% of samples. Among these isolates, 57.69% were multidrug-resistant, and 34.61% produced ESBL enzymes. This poses a serious public health concern, particularly because poultry is a significant source of protein in the country. Jordan is among the Levant countries with a high prevalence of AMR. Poultry farming plays a vital role in Jordan's food supply, with chicken being the most popular meat. However, numerous studies over the past 10 years have highlighted both the prevalence and the health risks posed by resistant bacteria in poultry products ( Al-Tamimi, et al., 2022 ; Gharaibeh, et al., 2024a ). Al-Qadiri, et al. (2025) documented the presence of MDR Salmonella spp. in chicken meat sourced from abattoirs and retail markets in Jordan. Similarly, Mayyas, et al. (2025) investigated C. jejuni from retail chicken and found resistance to fluoroquinolones and macrolides, the two principal antimicrobial classes used in the clinical management of campylobacteriosis. The detection of mcr-1 in E. coli isolates from broilers in northern Jordan, reported by Gharaibeh, et al. (2024a ), is particularly alarming. Colistin is considered a last-resort antibiotic for treating infections caused by carbapenem-resistant Enterobacteriaceae . The presence of mcr-1 in Jordanian poultry indicates that food animals could serve as reservoirs for this concerning resistance mechanism, which might be transferred to human pathogens. More recently, Al Momani, et al. (2024) detected colistin resistance genes in E. coli isolates from chicken meat and handlers, indicating risks for both workers and consumers. Since the implementation of standardized surveillance by EFSA and the European Centre for Disease Prevention and Control (ECDC), the EU has closely monitored AMR in foodborne poultry pathogens. Southern Europe, including Italy, Spain, and Greece, has well-established poultry industries and benefits from the EU's standardized surveillance system. Despite the 2006 ban on antibiotic growth promoters and subsequent restrictions on prophylactic antimicrobial use, resistant bacteria in chicken meat remain a significant issue. The 2023 EU One Health report found that resistance to fluoroquinolones and tetracyclines in C. jejuni from broilers exceeded 50% in several member states ( ECDC, 2024 ). S. enterica isolates from broiler meat also showed high resistance to ampicillin, sulfamethoxazole, and tetracycline. Nonetheless, resistance among Salmonella spp. to critically important antimicrobials, such as third-generation cephalosporins, was less common in countries with stringent controls. ( Ahmed, et al., 2025c ; Authority, et al., 2024 ; Bacci, et al., 2012 ). In Italy, Casella, et al. (2017) found that more than 60% of E. coli isolates from retail chicken meat were ESBL producers, primarily carrying CTX-M, TEM , and SHV genes ( Nsibi, et al., 2025 ). In Spain, recent genomic studies have revealed that cephalosporin-resistant E. coli strains harbour ESBL ( bla CTX-M-1 , bla CTX-M-14 , and bla SHV-12 ) and AmpC ( bla CMY-2 ) determinants, detected throughout the entire laying hen production cycle, in which IncI1 plasmids were the main platform for ESBL/AmpC genes ( Aldea, et al., 2022 ). However, some isolates harboured only bla TEM-1B or bla TEM-1D . ESBL-producing E. coli from retail poultry frequently belong to sequence type ST117 and carry IncI1-ST3 plasmids, indicating clonal spread through farms and meat supply chains ( Aldea, et al., 2022 ). Campylobacter poses a major challenge, as Greek poultry flock isolates exhibit high resistance to fluoroquinolones and tetracyclines among C. jejuni isolates, with resistance profiles similar to those observed in human isolates ( Natsos, et al., 2021 ). These findings suggest that AMR in poultry in the Mediterranean region follows consistent epidemiological patterns. In LMICs, the high prevalence of MDR and ESBL-producing bacteria is common and is associated with limited regulation of antimicrobial use and weak surveillance systems. In contrast, despite stricter antibiotic management policies in EU countries, resistance to critically important antibiotics, such as fluoroquinolones and tetracyclines, remains high, indicating the persistence of resistant strains despite regulatory control. Furthermore, differences in prevalence across countries appear to be influenced by antimicrobial practices, variations in biosecurity measures, slaughter practices, and food-handling systems. These findings highlight that a combination of regulatory, environmental, and production factors shapes AMR in poultry. The current evidence highlights the intrinsic link between food production and human health, demonstrating that MDR bacteria persist even in settings characterized by stringent surveillance and regulatory oversight. Figure 2 illustrates the transmission dynamics of Salmonella spp., Campylobacter spp., and E. coli within the poultry production chain, representing a complex ‘ farm-to-fork’ continuum, characterized by both vertical and horizontal dissemination. At the farm level, colonization is driven by environmental reservoirs, including contaminated feed, water, and litter, and vectors such as rodents, which facilitate rapid microbial contamination within poultry production units. As birds transition to the processing stage, the high-throughput nature of slaughter, specifically scalding and evisceration, serves as a critical amplification point where localized infections can lead to widespread cross-contamination of carcasses. This pathway concludes at the retail and consumer levels, where improper cold chain management and inadequate domestic hygiene practices may increase the risk of foodborne exposure to antimicrobial-resistant bacteria through poultry meat. Figure 2. Open in a new tab Conceptual framework illustrating the transmission pathways and contamination routes of Salmonella spp ., Campylobacte r spp., and E. coli along the poultry meat production chain, highlighting key points of contamination and the emergence and dissemination of antimicrobial resistance within a One Health framework. Central to this transmission cycle is the escalating emergence of AMR, particularly the proliferation of MDR and ESBL-producing strains. The historical use of antimicrobials for growth promotion and prophylaxis in intensive poultry farming has exerted considerable selective pressure, turning the avian gut into a crucible for horizontal gene transfer. Mobile genetic elements, such as plasmids and integrons, facilitate the rapid exchange of resistance determinants between commensal E. coli and pathogenic Salmonella or Campylobacter . This genetic plasticity ensures that once AMR emerges, it persists in the farm environment and spreads through the food chain, ultimately compromising clinical outcomes in humans by reducing the efficacy of critically important antimicrobials such as cephalosporins and fluoroquinolones. To effectively mitigate these risks, a One Health framework is essential, recognizing that the health of poultry, humans, and the shared environment is intimately linked. The discharge of poultry litter and wastewater onto agricultural lands introduces resistant pathogens and subtherapeutic antibiotic residues into soil and groundwater, creating environmental reservoirs that can reinfect livestock or may affect human populations through contaminated produce. A One Health approach to AMR in poultry meat production involves coordinated action and practical strategies across the animal, human, and environmental health sectors to promote responsible antimicrobial use and integrated surveillance, thereby limiting the emergence and spread of resistant bacteria. AMR patterns As summarized in Tables 1 – 3 , the prevalence and distribution of the predominant bacterial species isolated from poultry farms across the Mediterranean region are detailed, with particular emphasis on the proportion of MDR phenotypes identified among these isolates. Common trends indicate a relatively high prevalence of AMR in both EU countries (e.g., Italy, Spain, Greece) ( Mulchandani, et al., 2024 ) and non-EU countries (e.g., Egypt, Tunisia, Jordan), regardless of restrictions on the application of good agricultural practices ( Ahmed, et al., 2014 ; Al-Qadiri, et al., 2025 ; Elbehiry, et al., 2025 ; Oueslati, et al., 2021 , 2022 ). MDR among S. enterica, E. coli , and Campylobacter spp. isolated from poultry is widely documented in Lebanon, Morocco, and Jordan ( Dandachi, et al., 2018 ; Mayyas, et al., 2025 ; Soubai, et al., 2025 ). Heterogeneity in AMR prevalence across the Mediterranean region is probably driven, in part, by differences in surveillance intensity, regulatory enforcement, and antimicrobial stewardship frameworks. For instance, countries within the European Union generally report comparatively lower resistance rates, reflecting longstanding restrictions on the use of antimicrobial growth promoters and stringent veterinary oversight ( Mc Nulty, et al., 2016 ). In contrast, LMICs frequently exhibit elevated resistance burdens, often associated with unregulated or sub-optimally regulated antimicrobial use in food-animal production systems. LMICs exemplify this paradox: although the poultry sector constitutes a critical pillar of national food security and economic stability, surveillance infrastructures and regulatory mechanisms remain variably developed and inconsistently implemented ( Hedman, et al., 2020 ). The emergence and expansion of both AMR and MDR phenotypes, particularly those conferring resistance to critically important antimicrobials such as fluoroquinolones and colistin, in poultry production systems highlight an urgent need for synchronized national strategies aligned with regional and global One Health frameworks designed to mitigate spread risks across the animal-human-environment interface. Threats and public health implications of AMR in poultry meat Detecting AMR pathogens in poultry meat has important implications for human health, food safety, and global trade and threatens the effectiveness of antibiotics. Resistant bacteria associated with poultry may colonize humans gastrointestinal tract, potentially contributing to foodborne illness, transferring resistance genes to other pathogenic bacteria, and leading to medical complications ( Izah, et al., 2025 ). This impact is particularly severe for last-resort antibiotics such as colistin and carbapenems, for which resistance greatly limits available treatment options ( Jochum, et al., 2021 ). Foodborne illness is a leading cause of morbidity and fatality worldwide. Pathogens such as S. enterica, E. coli , and C. jejuni , commonly associated with poultry, are primary causes of gastroenteritis. Poultry are potential reservoirs of antibiotic resistance, comprising resistance to cephalosporins and carbapenems, which is considered critically important to human health. The fecal-oral route is the primary mode of transmission for these illnesses and for the occurrence of AMR in the population ( Hmidi, et al., 2025 ). Bacteria become resistant to antibiotics, resulting in severe, longer-lasting, and harder-to-treat infections. Azithromycin and fluoroquinolones are often the first-line treatment for invasive Campylobacter infections (CDC: https://www.cdc.gov/campylobacter/hcp/clinical-overview/index.html ). However, fluoroquinolone resistance in poultry-derived Campylobacter could exceed 50% in the Mediterranean ( Mayyas, et al., 2025 ). This may lead to treatment failures, necessitating alternative therapies or inpatient care for severe cases. Similarly, MDR among isolated Salmonella spp. poses a significant threat; since MDR strains cause other medical challenges such as more extended hospital stays, higher treatment costs, and an increased risk of sequelae complications ( Al-Qadiri, et al., 2025 ). Interestingly, in Lebanon, over 57% of poultry Salmonella spp. isolates were MDR, with resistance factors similar to those found in retail chicken in Jordan ( Al-Qadiri, et al., 2025 ; Khalife and El Safadi, 2024 ). These data may highlight the clinical risks of consuming contaminated poultry meat, prompting the health sector to adopt the WHO's One Health approach. Horizontal gene transfer and ESBLs β-lactams A principal mechanism underpinning antimicrobial resistance in poultry-associated E. coli is the production of ESBLs. The widespread detection of ESBL-encoding genes, mobile plasmids, and clonally related strains in poultry production systems gives compelling molecular evidence supporting the zoonotic transmission potential of MDR organisms across the animal–human interface. ESBL variants, including CTX-M, SHV , and TEM enzymes, mediate resistance to third-generation cephalosporins and other critically important β-lactams widely used in clinical practice ( Dandachi, et al., 2018 ). Meta-analytical estimates reveal that approximately 40% of E. coli isolates recovered from retail chicken meat in Europe exhibit an ESBL-producing phenotype ( Damianos, et al., 2025 ). Within the Mediterranean basin, prevalence rates are frequently higher. In France, ESBL-producing E. coli have been detected in up to 91.7% of retail poultry samples ( Casella, et al., 2017 ). Similarly, reported prevalence ranges between 30 and 40% in Tunisia and Egypt ( Hmidi, et al., 2025 ). Poultry production systems in Jordan likewise harbor ESBL-producing E. coli , with recent molecular analyses confirming the presence of CTX-M -type genes among broiler isolates ( Gharaibeh, et al., 2024a ). Collectively, these findings reveal the substantial reservoir of ESBL determinants within Mediterranean poultry supply chains and their implications for clinical and public health risk. The public health threat posed by ESBLs is amplified by their frequent localization on conjugative plasmids, which facilitate efficient horizontal gene transfer across bacterial populations and species boundaries. This plasmid-mediated mobility enables even commensal E. coli contaminating poultry meat to serve as reservoirs of resistance determinants, with the potential to subsequently transfer them to pathogenic bacteria within the human gastrointestinal tract ( Lambrecht, et al., 2021 ). Poultry-derived resistant strains may colonize the human gut microbiota asymptomatically, persist for extended periods, and establish a cryptic reservoir of antimicrobial resistance genes that can be mobilized under selective pressure. Epidemiological evidence indicates that individuals residing in proximity to livestock operations or consuming contaminated meat products exhibit an increased risk of colonization with ESBL-producing E. coli . In Mediterranean settings, where poultry consumption is high and hygienic handling practices may be inconsistently implemented, the likelihood of intestinal colonization is consequently substantial. Moreover, recent inquiries have documented the presence of resistant Gram-negative organisms among meat handlers and abattoir workers, underscoring occupational exposure as a significant transmission interface within the farm-to-fork continuum ( Ławniczek-Wałczyk, et al., 2025 ). Collectively, these findings reinforce the role of poultry production and processing environments as critical nodes in the dissemination of plasmid-mediated resistance within a One Health framework. Plasmid-mediated colistin resistance: mcr-1 and related variants One of the most alarming recent developments in AMR is the emergence of plasmid-mediated mcr genes conferring colistin resistance. Colistin, a polymyxin antibiotic, represents a last-line therapeutic option for infections caused by carbapenem-resistant Enterobacteriaceae and is not recommended for the routine management of MDR E. coli in the Mediterranean region ( Nsibi, et al., 2025 ). The initial identification of the transferable mcr-1 gene in E. coli isolates from pigs, poultry, and humans in China marked a paradigm shift in our understanding of colistin resistance, demonstrating for the first time its horizontal transmissibility ( Liu, et al., 2016 ). mcr-1 remains the most prevalent mcr variant globally and is the genotype most frequently associated with human clinical infections ( Microbiology, 2022 ). Subsequently, mcr-1 has been detected in poultry meat and production systems across multiple continents, including Europe and Africa, as well as throughout the Mediterranean basin. Notably, circulation of mcr-1 –harboring strains has been documented on poultry farms in Greece, pointing to the potential erosion of colistin efficacy as a last-resort agent and reinforcing the urgency of coordinated resistance surveillance ( Xexaki, et al., 2023 ). For instance, in Jordan, the presence of mcr-1 in E. coli isolates recovered from broiler meat confirms that this critical resistance determinant has entered the local food supply ( Gharaibeh, et al., 2024a ). However, increasing reports of colistin resistance in Egypt and Tunisia further highlight its regional dissemination ( Hmidi, et al., 2025 ). The detection of mcr-1 in poultry production systems is especially alarming in LMICs, where colistin has historically been used as a growth promoter or for prophylactic purposes, thereby exerting substantial selective pressure favoring resistant strains. The plasmid-borne nature of mcr-1 markedly enhances its potential for horizontal transfer to clinically significant pathogens, including Klebsiella pneumoniae and Acinetobacter baumannii , amplifying the risk of untreatable infections in both community and healthcare settings ( Dandachi, et al., 2018 ). These observations confirm the critical need for tough antimicrobial stewardship and integrated One Health surveillance to curb the dissemination of plasmid-mediated colistin resistance. Carbapenem resistance Carbapenems constitute a critically important class of last-resort β-lactam antibiotics for the treatment of infections caused by MDR Gram-negative pathogens. Although their use in veterinary medicine remains highly restricted, the emergence of carbapenem-resistant Enterobacteriaceae (CRE) within the food production continuum is of growing public health concern. CRE has been detected in poultry meat, particularly in Asia Ramírez-Castillo, et al. (2023) , with Zhang, et al. (2019) documenting carbapenemase-producing Enterobacteriaceae in retail chicken in China, and additional sporadic cases reported in the Mediterranean region ( Nsibi, et al., 2025 ; Sadek, 2020 ). To date, widespread carbapenem resistance has not been reported in poultry production systems. Nevertheless, the increasing prevalence of ESBL-producing and colistin-resistant Enterobacteriaceae in poultry elicits concern regarding the potential emergence of carbapenem resistance under intensified selective pressure ( Dankittipong, et al., 2023 ). The regional dissemination of clinically relevant carbapenemase genes, including NDM -1 and OXA -48, further stresses the risk of horizontal gene transfer into bacteria associated with the poultry food chain. Such events would pose substantial challenges for the clinical management of severe human infections ( Chaalal, et al., 2021 ). Beta-lactam resistance High rates of resistance to ampicillin and amoxicillin/clavulanic acid have been consistently reported among poultry-associated E. coli and Salmonella spp. in Mediterranean countries ( Al-Qadiri, et al., 2025 ; Khalife and El Safadi, 2024 ; Oueslati, et al., 2022 ; Salem, et al., 2025 ). This resistance is largely attributed to the extensive dissemination of plasmid-mediated β-lactamases, facilitated by sustained antimicrobial use in poultry production systems ( Khalifa, et al., 2025 ; Khalife and El Safadi, 2024 ). Although the β-lactamase inhibitor clavulanic acid can partially restore β-lactam efficacy, increasing resistance to amoxicillin/clavulanic acid has been documented, underscoring growing concerns regarding the sustained clinical utility of first-line β-lactams for the management of zoonotic infections ( El Hage, et al., 2020 ). Resistance to extended-spectrum cephalosporins (ESC) Resistance to extended-spectrum cephalosporins (ESC) has been documented globally among bacteria associated with food-producing animals, a trend likely linked to the historical and, in some settings, ongoing veterinary use of cephalosporins ( Che, et al., 2023 ). In particular, resistance to second- and third-generation cephalosporins, including cefuroxime and ceftriaxone, is strongly associated with the emergence and dissemination of ESBL-producing Enterobacteriaceae in poultry meat ( Eltai, et al., 2020 ). ESBLs are hydrolytic enzymes that inactivate extended-spectrum cephalosporins and other β-lactam antibiotics, thereby substantially limiting their therapeutic efficacy ( Abdallah, et al., 2025 ). ESBL-producing E. coli and Salmonella spp. are widely reported across Mediterranean countries, with CTX - M -type enzymes predominating ( Fournier, et al., 2020 ). Notably, despite regulatory restrictions or bans on cephalosporin use in poultry, the continued detection of these resistance determinants illustrates the genetic stability and persistence of ESBL-encoding genes within the poultry production continuum ( Che, et al., 2023 ). Aminoglycoside resistance Moderate levels of gentamicin resistance have been reported among poultry-derived E. coli and Salmonella spp., constituting a notable public health concern ( Cerqueira-Cézar, et al., 2025 ). This resistance may arise in part through co-selection driven by the use of lincomycin–spectinomycin combinations in poultry production systems ( Cox, et al., 2022 ). At the molecular level, aminoglycoside resistance is frequently mediated by highly mobile aminoglycoside-modifying enzymes, whose encoding genes are disseminated via plasmids, integrons, transposons, and other mobile genetic elements, often co-localized with additional resistance determinants such as 16S rRNA methyltransferases (RMTases) or β-lactamase genes ( Garneau-Tsodikova and Labby, 2016 ). Aminoglycoside resistance is commonly observed in Salmonella spp., and although tetracycline resistance is primarily associated with the acquisition of tetA and tetB genes ( Kumar, et al., 2025 ), and the co-occurrence of multiple resistance determinants is frequent. Consequently, gentamicin resistance often presents alongside resistance to other antimicrobial classes, thus contributing to multidrug-resistant phenotypes in poultry-associated bacterial populations ( Mudenda, et al., 2023 ). Protein synthesis inhibitors High rates of tetracycline resistance are consistently documented among poultry-associated Campylobacter spp., E. coli , and Salmonella spp., reflecting sustained selective pressure in intensive production systems. Notably, a study in Tunisia reported a 100% prevalence of tetracycline resistance genes among broiler chickens, underscoring the extensive historical use of tetracyclines in poultry farming and the consequent fixation of resistance determinants within these bacterial populations ( Di Francesco, et al., 2021 ). In contrast, resistance to chloramphenicol remains comparatively low following its prohibition in food-producing animals in the European Union due to its genotoxic effects and potential carcinogenicity ( Pipoyan, et al., 2025 ; Wang, et al., 2004 ). Nevertheless, the continued detection of chloramphenicol resistance genes indicates their persistence in the poultry reservoir, likely maintained through co-selection mechanisms associated with the use of other antimicrobial agents. Macrolide resistance Macrolides, including erythromycin and azithromycin, are classified by the WHO as critically important antimicrobials for the treatment of human campylobacteriosis ( Trott, et al., 2021 ). Although macrolide resistance in poultry-associated Campylobacter spp. generally remains lower than resistance to fluoroquinolones, an upward trend has been reported in several Mediterranean countries ( Lopez-Chavarrias, et al., 2021 ; Pergola, et al., 2017 ; Trott, et al., 2021 ). Resistance levels in C. jejuni are typically low, whereas macrolide resistance is more frequently observed in C. coli . High-level macrolide resistance is predominantly mediated by point mutations in the 23S rRNA gene, particularly the A2075G substitution and, less commonly, A2074C or A2074G mutations, thereby compromising the efficacy of first-line therapeutic regimens ( Bolinger and Kathariou, 2017 ). Quinolone and fluoroquinolone resistance Extensive use of fluoroquinolones in poultry production has driven the emergence of resistance to nalidixic acid and ciprofloxacin among poultry-associated Campylobacter spp. and Enterobacteriaceae in the Middle Euphrates region ( Shakir, et al., 2021 ). The EFSA 2021–2022 surveillance report on C. jejuni and C. coli from human and animal sources documented high to extremely high levels of resistance to fluoroquinolones, prompting the recommendation against their use for the treatment of human campylobacteriosis ( Smith and Fratamico, 2010 ). Fluoroquinolone-resistant Campylobacter strains have been frequently isolated from poultry feces and carcasses, with prevalence rates exceeding 50%, predominantly attributable to point mutations in the gyrA gene. Importantly, resistance has been shown to persist even in production systems where fluoroquinolone use has been curtailed, suggesting limited reversibility once resistance determinants become established in bacterial populations ( Smith and Fratamico, 2010 ). Sulfonamide resistance Elevated resistance rates to trimethoprim–sulfamethoxazole are frequently observed among poultry-associated E. coli and Salmonella spp. ( Assoumy, et al., 2021 ). This resistance is predominantly mediated by mobile genetic elements, particularly class 1 integrons harboring sul1, sul2 , and dfrA gene cassettes, which facilitate horizontal dissemination across bacterial populations. Notably, trimethoprim-sulfamethoxazole resistance commonly co-occurs with resistance to β-lactams and tetracyclines, thereby contributing to the emergence and persistence of multidrug-resistant phenotypes in poultry-derived isolates ( Partridge, et al., 2018 ). Economic and trade consequences of AMR bacteria in poultry production The emergence of AMR bacteria in poultry meat has substantial economic and public health implications. Poultry-exporting countries that harbor resistant pathogens are increasingly subject to trade restrictions, border rejections, and unauthorized imports. For instance, poultry products from Poland have been repeatedly flagged in the EU Rapid Alert System for Food and Feed, and imported poultry is subjected to rigorous inspection for pathogenic microorganisms-primarily Salmonella spp.-and other microbial contaminants ( Eissa, et al., 2025 ). Similarly, exporters in Mediterranean countries face regulatory challenges resulting from stringent EU standards for antimicrobial resistance in food imports ( Pigłowski, et al., 2025 ). Beyond trade, AMR imposes a significant economic burden on healthcare systems, including prolonged hospitalizations, increased diagnostic testing, and elevated costs of antimicrobial therapy ( Dadgostar, 2019 ). A 2017 World Bank estimate projects that, if unmitigated, AMR could reduce global gross domestic product by up to 3.8% by 2050, with low- and middle-income countries bearing the greatest economic impact ( Group, 2018 ). The risks associated with AMR in poultry are varied. Clinically, resistant strains such as Salmonella and Campylobacter complicate the treatment of foodborne infections ( Al-Qadiri, et al., 2025 ; Mayyas, et al., 2025 ). The emergence of ESBL-producing bacteria reduces the efficacy of penicillins and cephalosporins, while the dissemination of mcr-1 in Enterobacterales raises concerns about the potential failure of last-resort antibiotics ( Abdallah, et al., 2025 ). Beyond clinical outcomes, human-inhabiting resistant bacteria can facilitate the horizontal transfer of resistance genes and pose ongoing threats to the global poultry trade, particularly given the intertwined health and economic consequences of AMR across the food production continuum ( Abou-Jaoudeh, et al., 2024 ). Intervention strategies in poultry production for mitigating antimicrobial resistance Mitigation of AMR in poultry production requires a systems-based, farm-to-fork approach integrating coordinated interventions across the entire value chain. Although stewardship initiatives have predominantly concentrated on optimizing antimicrobial use at the primary production level, growing evidence indicates that downstream control measures are equally critical. Decontamination and pathogen-reduction strategies play a central role in reducing microbial contamination and may lower consumer exposure to AMR bacteria; however, a reduction in bacterial load does not necessarily correspond to a reduction in AMR ( Hedman, et al., 2020 ; Mangalea, et al., 2024 ). Recent advances have further broadened the intervention landscape by examining innovative alternatives to conventional antimicrobial agents, including non-antibiotic therapeutics, microbiome-modulating approaches, and enhanced biosecurity technologies. These developments emphasize the urgent need for sustainable, integrated mitigation frameworks that simultaneously preserve antimicrobial efficacy, maintain poultry health and productivity, and protect public health ( Hedman, et al., 2020 ). Farm-level strategies and biosecurity measures Reduction of unnecessary antimicrobial use at the primary production level remains the cornerstone of AMR mitigation in poultry systems. The experience of the European Union demonstrates the feasibility and impact of regulatory action: the 2006 ban on AGPs was associated with a measurable decline in antimicrobial consumption across Member States, although its implementation required substantial structural and management adjustments ( European Commission, 2003 ). In contrast, in several Mediterranean countries, antimicrobials continue to be widely administered for prophylactic purposes and as growth promoters, often in the absence of robust risk assessment frameworks or antimicrobial stewardship oversight ( Al Bakri, et al., 2025 ). This discrepancy underscores continuing regulatory and enforcement gaps that may facilitate the selection and dissemination of resistant bacteria. Vaccination represents a critical non-antibiotic intervention to reduce infection pressure and, consequently, therapeutic antimicrobial demand. Targeted immunization against key poultry pathogens, including Salmonella spp. and E. coli , has demonstrated effectiveness in decreasing pathogen carriage and environmental contamination. Commercial vaccines have been successfully deployed in EU poultry systems to reduce Salmonella prevalence in broiler flocks, thereby lowering bacterial loads entering processing plants ( Methner, 2007 ). Expanded implementation of vaccination programs in Mediterranean production systems could substantially mitigate pathogen transmission along the production continuum. Comprehensive biosecurity and stewardship frameworks are equally indispensable. Core measures include strict control of human and animal movement, equipment sanitation, flock segregation, and adherence to good agricultural and hygienic practices. These interventions, combined with farmer education and training, enforcement of prescription-only antimicrobial policies, and establishment of effective veterinary oversight systems, constitute essential components of sustainable antimicrobial stewardship ( Issa-Zacharia, et al., 2025 ). Empirical evidence from Mediterranean production contexts indicates that farms implementing stringent biosecurity protocols could be associated with a lower prevalence of AMR Campylobacter spp. and E. coli strains. Strengthening biosecurity infrastructure, particularly in small- and medium-scale operations, might significantly lower pathogen burdens at slaughter and interrupt the amplification and dissemination of resistant bacteria within the poultry value chain ( Newell, et al., 2011 ). Alternatives to antimicrobials on farms The progressive restriction of prophylactic antimicrobial use in poultry production has accelerated the investigation of non-antibiotic alternatives to maintain animal health and productivity while mitigating the selection pressure for AMR. Among the most promising strategies are probiotics, prebiotics, phytobiotics (plant-derived bioactive compounds), and bacteriophage-based therapies, all of which are being evaluated as functional substitutes for conventional antimicrobials ( Rachwał and Gustaw, 2025 ). Dietary probiotic supplementation in broiler systems has demonstrated efficacy in modulating gut microbiota composition, enhancing intestinal barrier integrity, and competitively excluding enteric pathogens. Experimental and field studies report reduced colonization by Salmonella spp. and Campylobacter spp., accompanied by improvements in zootechnical performance indicators, including increased body weight gain, enhanced feed intake, and reduced feed conversion ratio ( Śmiałek, et al., 2021 ). These dual benefits-pathogen control and performance optimization-underscore the translational potential of microbiome-targeted interventions. Similarly, bacteriophage-based biocontrol strategies are gaining traction as highly specific, self-amplifying antimicrobial tools. Phage preparations targeting E. coli and Salmonella spp. are currently under experimental evaluation in poultry production systems in Germany. Preliminary findings show substantial reductions in bacterial load without adverse effects on growth performance or production efficiency ( Bogun, et al., 2024 ). Collectively, these approaches represent biologically targeted, resistance-mitigating alternatives that could support sustainable intensification of poultry production while preserving antimicrobial efficacy. Technological and Processing-Based Interventions Interventions at the processing stage constitute a critical control point for mitigating microbial contamination of poultry carcasses and derived meat products. Given that resistant pathogens entering slaughter facilities may disseminate along the processing line, the implementation of validated decontamination technologies is essential to reduce bacterial load and downstream consumer exposure. A range of chemical and non-thermal interventions has been evaluated and adopted internationally. Peracetic acid (PAA) Peracetic acid (PAA) is widely used in the United States and is increasingly used in the European Union as a carcass rinse or spray intervention. Empirical studies demonstrate that PAA treatments can achieve reductions of 1-3 log CFU/cm² in Salmonella spp. and Campylobacter spp. on broiler carcasses, depending on concentration, exposure time, and application method ( Moore, et al., 2017 ; Zhang, et al., 2024 ). PAA decomposes into acetic acid, oxygen, and water, thereby minimizing harmful residues and environmental impact. Its broader adoption in Mediterranean poultry processing facilities could provide an immediately deployable risk-reduction strategy ( Zhang, et al., 2024 ). High-pressure processing (HPP) High-pressure processing (HPP) is a non-thermal preservation technology that subjects packaged poultry products to hydrostatic pressures of up to 600 MPa, resulting in membrane disruption and cellular inactivation while preserving sensory and nutritional quality. HPP has been shown to achieve >5-log reductions in major foodborne vegetative pathogens and spoilage organisms, including Salmonella spp., E. coli , and L. monocytogenes , in poultry meat matrices ( Cap, et al., 2020 ; Shahein, et al., 2023 ). Although capital-intensive, HPP offers strategic value to export-oriented producers in Mediterranean countries seeking to comply with stringent international microbiological criteria. Importantly, current evidence suggests that hydrostatic pressure treatment does not promote the development of antimicrobial resistance, reinforcing its suitability within AMR mitigation frameworks ( Rendueles, et al., 2011 ; Shahein, et al., 2023 ). Ozone application Ozone, applied in gaseous or aqueous form, has emerged as an alternative antimicrobial intervention in poultry processing. Owing to its strong oxidative properties, ozone effectively reduces contamination by Salmonella spp. and Campylobacter spp., though achieving uniform treatment across complex carcass surfaces remains technically challenging ( Megahed, et al., 2020 ). A key advantage is its rapid decomposition into oxygen, leaving no chemical residues on treated products ( Xue, et al., 2023 ). When appropriately applied, ozone treatment does not appear to induce antimicrobial resistance, further supporting its integration into sustainable decontamination strategies ( Giménez, et al., 2024 ). Electrolyzed water Neutral electrolyzed water has gained recognition as a safe, cost-effective antimicrobial intervention for poultry processing environments. Rahman, et al. (2012) demonstrated that electrolyzed water significantly reduced microbial counts on poultry meat without adversely affecting sensory attributes. Compared with other chemical sanitizers, electrolyzed water systems are relatively inexpensive and operationally feasible, making them particularly suitable for implementation in resource-limited settings in poultry production systems ( Al-Qadiri, et al., 2016 ). Chlorine and organic acid rinses Chlorine-based rinses are still used in some countries as contact sanitizers to reduce microbial contamination during poultry processing. However, their acceptance in international trade is limited; notably, chlorine-washed poultry is prohibited within the EU. Concerns include the potential formation of chlorinated byproducts, residual chlorine on treated surfaces, and diminished antimicrobial efficacy in the presence of organic matter ( McWhorter, et al., 2022 ). Organic acids have been proposed as comparatively safer alternatives, offering broad-spectrum antimicrobial activity against foodborne pathogens with a lower risk of adverse health effects. Nevertheless, potential impacts on organoleptic properties may constrain their application ( Chousalkar, et al., 2019 ; McWhorter, et al., 2022 ). Organic acids-including lactic, acetic, citric, and propionic acids-exert antimicrobial effects primarily through environmental acidification, disruption of microbial cellular homeostasis, and intracellular acidification following membrane penetration, leading to enzyme inactivation and DNA denaturation ( Sorathiya, et al., 2025 ). Collectively, these interventions offer diverse technological options to reduce microbial contamination; however, their effectiveness depends on the prevalence and persistence of resistant strains within the microbial population. One health approach as a framework for action The accelerating emergence and dissemination of drug-resistant pathogens point to the need for integrative governance frameworks that transcend traditional sectoral and disciplinary boundaries. The WHO, FAO, World Organisation for Animal Health (WOAH), and United Nations Environment Programme (UNEP) collectively conceptualize the One Health approach as “an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems,” thereby promoting coordinated, multisectoral action to advance global health security and sustainable development. Within this framework, harmonization of surveillance systems, systematic data sharing, collaborative response mechanisms, and coherent policy architectures across local, national, regional, and global levels are regarded as foundational pillars. Such structural alignment enhances collective capacity to detect, prevent, and mitigate complex health threats arising at the human-animal-environment interface ( Adisasmito, et al., 2022 ; World Health Organization, et al., 2022 ). The One Health paradigm signals the necessity of multisectoral and transdisciplinary collaboration among public health, veterinary medicine, agriculture, food safety, and environmental sciences to address complex health threats emerging at the human-animal-environment interface ( Sleeman, et al., 2025 ). Zoonotic infections, foodborne diseases, and AMR exemplify interconnected risks that cannot be effectively mitigated within isolated institutional silos. Instead, these challenges reflect shared ecological and epidemiological drivers that link human populations, domestic and wild species, plant systems, and broader ecosystems ( Rodriguez, 2024 ; World Health Organization, et al., 2022 ). Operationalizing One Health in the context of AMR requires strategic engagement of sectors responsible for antimicrobial stewardship in human and veterinary medicine, environmental risk mitigation, and integrated surveillance infrastructures. Recognition that inappropriate antimicrobial use across sectors accelerates the dissemination of resistance reinforces the urgency of coordinated governance and shared accountability. By institutionalizing interdisciplinary cooperation and synchronized policy implementation, the One Health framework provides a comprehensive platform for anticipating, preventing, detecting, and responding to emerging resistance threats while advancing resilient, equitable, and sustainable health systems worldwide ( Ahmed, et al., 2024 ). Post-processing controls alone are insufficient to eliminate consumer exposure to resistant foodborne pathogens; targeted interventions at the retail and household levels remain critical. Public health education campaigns that promote safe handling of raw poultry, adequate thermal processing, and prevention of cross-contamination within domestic kitchens have demonstrated substantial potential to reduce transmission risk. In Mediterranean settings, where informal markets and wet shops constitute a significant component of poultry retail, consumer-focused risk communication strategies may yield particularly meaningful reductions in exposure. Sustainable mitigation of AMR in poultry production extends beyond technological interventions and demands strong policy architectures grounded in One Health principles. The WHO guidelines (2017) explicitly recommend the cessation of medically important antimicrobials for growth promotion in food-producing animals ( Aidara-Kane, et al., 2018 ). Beyond the food chain, poultry production adds to environmental dissemination of resistant bacteria through manure application, wastewater discharge, and farm effluents, therefore reinforcing environmental reservoirs of resistance ( Bhushan, et al., 2017 ). Notably, drinking water sources represent a critical risk factor: farms supplied by artesian wells have been shown to exhibit a higher prevalence of MDR E. coli than those supplied by municipally treated water ( Ibrahim, et al., 2019 ). Such environmental pathways can amplify resistance selection and facilitate reintroduction of resistant strains into human populations ( World Health Organization, 2017 ). Although Mediterranean countries are progressively coinciding with international stewardship objectives, implementation remains heterogeneous. Harmonized regional surveillance systems would enable cross-country comparison of resistance trends and facilitate the exchange of best practices. The WHO Tricycle Project provides a standardized technical protocol for monitoring ESBL-producing E. coli across the human, animal, and environmental sectors, delivering a scalable model for integrated global surveillance under a One Health framework ( World Health Organization, 2017 ). Adoption of this protocol across Mediterranean countries could represent a cost-effective entry point for coordinated ESBL- E. coli monitoring ( Ruppé, 2023 ). In parallel, international trade standards established under the Codex Alimentarius Commission (2021) outline structured risk analysis frameworks for foodborne AMR, supporting evidence-based regulatory decision-making and facilitating alignment with global food safety benchmarks ( Commission, 2011 [revised 2021]). Integration of these standards into national legislation would strengthen policy coherence and reduce the risk of trade disruptions. Enhanced regional collaboration-potentially through multilateral platforms such as the Union for the Mediterranean and the Arab League-could further promote data harmonization, technical capacity building, and coordinated policy implementation across the Mediterranean basin. Future directions and policy strategies for AMR mitigation in poultry production Addressing persistent gaps in AMR mitigation requires context-specific innovation that simultaneously reduces microbial contamination in meat and poultry products, extends shelf life, and preserves nutritional and organoleptic quality. Future research needs to prioritize scalable, cost-effective technologies suitable for LMICs. Among these, advanced aqueous sanitization systems represent a promising intervention, offering antimicrobial efficacy, operational simplicity, and economic feasibility as both sanitizers and surface decontaminants ( Rahman, et al., 2012 ; Yan, et al., 2021 ). Emerging antimicrobial alternatives grounded in nanotechnology, collectively termed nanobiotics, are gaining attention as next-generation tools for microbial control. These include inorganic, organic, carbon-based, and hybrid nanomaterials with demonstrated bactericidal properties. Nanobiotics may offer targeted surface decontamination of meat products and potential therapeutic applications against MDR pathogens without exerting conventional selective pressure mechanisms associated with antibiotics. Nonetheless, comprehensive toxicological assessment and regulatory oversight remain imperative to address safety considerations before large-scale implementation ( Mateen, et al., 2025 ). Bacteriophage-based interventions also represent a translationally advanced strategy. Commercial phage cocktails have been approved in selected Mediterranean countries for application in poultry processing environments and have demonstrated safety and efficacy in controlling enteric pathogens, particularly E. coli and Salmonella spp. ( Huang, et al., 2022 ; Mateen, et al., 2025 ). Their high host specificity and self-limiting replication dynamics make them attractive tools within integrated AMR mitigation frameworks. Plant-derived antimicrobials (phytobiotics) constitute another promising class of bioactive compounds. Essential oils derived from citrus, pepper, sage, thyme, cinnamon, oregano, and anise, along with polyphenols, alkaloids, and organosulfur compounds, exhibit broad-spectrum antimicrobial activity. Mechanistically, these agents inhibit biofilm formation and quorum sensing, disrupt cell membrane integrity, and interfere with nucleic acid and protein synthesis. Notably, certain phytobiotics demonstrate synergistic interactions when combined with antibiotics or complementary natural compounds, possibly boosting efficacy while reducing required dosages. However, large-scale application in Mediterranean production systems necessitates further validation of antimicrobial potency, formulation stability, sensory impact, and cost-effectiveness ( Rachwał and Gustaw, 2025 ). Comprehensive AMR mitigation in poultry production must integrate biosecurity and immune-based strategies across the continuum, from farm-level management and antimicrobial stewardship to advanced processing technologies and consumer education ( Kurćubić, et al., 2025 ). In Mediterranean contexts, implementation of evidence-based interventions such as general chemical sanitization treatments, advanced aqueous decontamination protocols, and strengthened farm biosecurity is both feasible and urgently warranted. However, durable impact depends on upstream structural reforms, including reduced antimicrobial usage, expanded vaccination programs, adoption of probiotics, and robust One Health-aligned policy frameworks targeting the ecological and socioeconomic drivers of resistance ( Ahmed, et al., 2025a ). Finally, socioeconomic determinants, including financial constraints, limited access to veterinary services, and market demand for low-cost poultry products, substantially influence antimicrobial reliance at the farm level. Rigorous, interdisciplinary research is therefore required to design targeted, economically viable interventions that align public health objectives with producer sustainability and consumer affordability. Although these interventions may reduce contamination and consumer exposure, their long-term effectiveness depends on coordinated implementation, robust regulatory enforcement, and strengthened monitoring across the entire poultry production chain. Implementation challenges and policy coordination From a public health perspective, the effective implementation of AMR mitigation strategies in poultry production remains a major concern, particularly in Mediterranean and Middle Eastern contexts ( Harb, et al., 2019 ). Despite the availability of technically validated interventions, multiple system-wide barriers impede adoption. Key challenges include weak regulatory enforcement, widespread availability of low-cost antimicrobials leading to unsupervised or inappropriate use, low levels of awareness and understanding of AMR among farmers, and the absence of robust surveillance systems capable of accurately quantifying resistance burden ( Abou-Jaoudeh, et al., 2024 ; Al Bakri, et al., 2025 ; World Health Organization and Mediterranean, 2017 ). In regions where poultry is predominantly sold through traditional slaughterhouses or wet markets, hygiene standards are often suboptimal, and consumer awareness of safe handling practices is limited. Economic constraints-including the costs associated with implementing safe handling or decontamination measures-further undermine stewardship initiatives. These challenges are compounded by significant data gaps: limited or inconsistent surveillance across Mediterranean countries hinders cross-country comparison of resistance trends and constrains evidence-based evaluation of intervention effectiveness ( Nacer, et al., 2022 ; World Health Organization and Mediterranean, 2017 ). This multi-dimensional landscape stresses the need for integrated strategies that combine regulatory reinforcement, farmer education, consumer engagement, and harmonized surveillance frameworks designed to ensure sustainable implementation of AMR mitigation measures. Global health authorities, including the WHO and FAO, strongly advocate reducing antimicrobial use in food-producing animals as a central strategy to mitigate AMR ( FAO, 2023 ; World Health Organization and Mediterranean, 2017 ). Mediterranean countries could benefit from aligning national regulatory frameworks with the Codex Alimentarius Commission guidelines for AMR risk analysis, thereby harmonizing policy with internationally recognized standards ( Commission, 2011 [revised 2021]). Collaborative initiatives, such as EU technical and financial support for neighboring Mediterranean states, offer important mechanisms to strengthen surveillance infrastructure, regulatory enforcement, and risk-based intervention capacity ( ECDC, 2026 ) Key strategies include the rational reduction of antimicrobial use, reinforcement of farm biosecurity, and the adoption of vaccines and probiotics to maintain flock health while minimizing reliance on antibiotics ( Anthony, et al., 2001 ). In Mediterranean contexts, the establishment of strong regulatory frameworks integrated within a One Health approach is urgently needed. Phasing out the use of antimicrobials and growth promoters, supported by international collaboration and context-specific technological and management innovations, represents the most workable pathway toward sustainable AMR control ( Hammerum, et al., 2007 ; World Organisation for Animal Health, 2023 ). Without coordinated, multi-sectoral action, resistant pathogens in poultry will continue to propagate, threatening local populations and compromising regional and global health security. Conclusions AMR in poultry meat represents a major food safety concern and a broader One Health challenge with significant implications for public health, food security, and economic stability. Poultry production is recognized as an important reservoir for the dissemination of resistant bacteria, including Salmonella spp., Campylobacter spp., and E. coli , which are frequently isolated from retail chicken meat and may contribute to humans exposure through the food chain. The Mediterranean region illustrates these challenges due to high poultry consumption and variable regulatory frameworks. Southern European countries operate under strict EU regulations but still report high prevalence of ESBL-producing E. coli and fluoroquinolone-resistant Campylobacter . In contrast, North African countries often face weaker regulatory enforcement and widespread antimicrobial use, while Eastern Mediterranean countries such as Lebanon and Jordan experience additional pressures from limited surveillance systems and high reliance on poultry production. Recent studies across the region report MDR Salmonella spp., fluoroquinolone- and macrolide-resistant Campylobacter spp., ESBL-producing E. coli , and the emergence of mcr-1 , indicating resistance to last-resort antibiotics within the food chain. Addressing this issue requires interventions across the entire farm-to-fork continuum, including antimicrobial stewardship, improved biosecurity, vaccination, and good farming practices. However, sustainable control of AMR will depend on coordinated One Health policies, strengthened surveillance, and stricter regulatory enforcement across human, animal, and environmental health sectors. Strengthening regional collaboration and stewardship efforts is therefore essential to limit the spread of resistant pathogens and protect the effectiveness of life-saving antimicrobials. Disclosures The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this review. Data availability Data will be provided upon request. Funding No external funding was received to support this work. CRediT authorship contribution statement Amal Mayyas: Writing – original draft, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation. Hamzah M. Al-Qadiri: Writing – original draft, Methodology, Funding acquisition, Formal analysis, Data curation, Conceptualization. Murad A. Al-Holy: Methodology, Investigation. Amin N. Olaimat: Methodology, Investigation, Data curation, Conceptualization. Aseel AbuAlshaar: Data curation, Conceptualization. Islam Hamad: Methodology, Data curation, Conceptualization. Rula A. Amr: Data curation, Conceptualization. Ali Al-Samydai: Data curation, Conceptualization. Hussein Al-Maharmeh: Data curation, Conceptualization. Zeinab M.H. Mahasneh: Writing – review & editing, Writing – original draft, Formal analysis. Disclosures The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this review. Acknowledgments We thank the Deanship of Scientific Research at the University of Jordan and the Faculty of Health Sciences at the American University of Madaba for their support throughout this project. Contributor Information Amal Mayyas, Email: a.mayyas@aum.edu.jo. Hamzah M. Al-Qadiri, Email: h.qadiri@ju.edu.jo. Murad A. Al-Holy, Email: murad@hu.edu.jo. Amin N. Olaimat, Email: aminolaimat@hu.edu.jo. Aseel AbuAlshaar, Email: a.abualshaar@aum.edu.jo. Islam Hamad, Email: i.hamad@aum.edu.jo. Rula A. Amr, Email: r.Amr@aum.edu.jo. Ali Al-Samydai, Email: a.alsamydai@ammanu.edu.jo. Hussein Al-Maharmeh, Email: hmalmaharmeh22@med.just.edu.jo. Zeinab M.H. Mahasneh, Email: z_mahasneh@ju.edu.jo, Z.mahasneh@jpu.edu.jo. References Abdallah K., Tayh G., Maamar E., Mosbah A., Abbes O., Fliss I., Messadi L. Genotypic characterisation and risk assessment of virulent ESBL-producing E. coli in chicken meat in Tunisia: insights from Multi-Omics Machine Learning perspective. Microbiol. Res. 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