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. 2021 Jan 26;12:100220. doi: 10.1016/j.onehlt.2021.100220

Box 1.

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Two mechanisms of resistance driven by antibacterial exposure. First, antibacterial use selects resistant bacteria already present in the compartment (A), and second that antibacterial use can remove susceptible populations making transmission more likely (B). In (B), it is more likely for colonisation with resistant bacteria to occur when the native flora have been removed (via a ‘bacteriological vacuum’ - an absence of bacteria).