Antimicrobial resistance (AMR) is a growing public health challenge that is expected to disproportionately burden lower- and middle-income countries (LMICs) in the coming decades. Although the contributions of human and veterinary antibiotic misuse to this crisis are well-recognized, environmental transmission (via water, soil or food contaminated with human and animal faeces) has been given less attention as a global driver of AMR, especially in urban informal settlements in LMICs—commonly known as ‘shanty towns’ or ‘slums’. These settlements may be unique hotspots for environmental AMR transmission given: (1) the high density of humans, livestock and vermin living in close proximity; (2) frequent antibiotic misuse; and (3) insufficient drinking water, drainage and sanitation infrastructure. Here, we highlight the need for strategies to disrupt environmental AMR transmission in urban informal settlements. We propose that water and waste infrastructure improvements tailored to these settings should be evaluated for their effectiveness in limiting environmental AMR dissemination, lowering the community-level burden of antimicrobial-resistant infections and preventing antibiotic misuse. We also suggest that additional research is directed towards developing economic and legal incentives for evaluating and implementing water and waste infrastructure in these settings. Given that almost 90% of urban population growth will occur in regions predicted to be most burdened by the AMR crisis, there is an urgent need to build effective, evidence-based policies that could influence massive investments in the built urban environment in LMICs over the next few decades.

抗菌素耐药性（AMR）是一个日益严重的公共卫生挑战，预计在未来几十年中，它将对中低收入国家（LMIC）造成不成比例的负担。尽管人们已充分认识到人类和兽医滥用抗生素对这场危机的贡献，但作为抗菌药物耐药的全球驱动因素，环境传播（通过水，土壤或人类和动物粪便污染的食物）受到的关注较少，特别是在城市非正规住区在中低收入国家（通常称为“棚户区”或“贫民窟”）中。在以下情况下，这些定居点可能是环境AMR传播的独特热点：（1）居住在附近的高密度的人类，牲畜和害虫；（2）经常滥用抗生素；（3）饮用水，排水和卫生基础设施不足。这里，我们强调需要制定策略来扰乱城市非正规住区中的环境AMR传播。我们建议应针对这些环境量身定制水和废物基础设施的改进措施，以评估其在限制环境AMR传播，减轻社区一级抗药性感染负担和防止滥用抗生素方面的有效性。我们还建议，应进行更多研究，以开发经济和法律激励措施，以评估和实施这些环境中的水和废物基础设施。鉴于将近90％的城市人口增长将出现在预计将受到AMR危机最大负担的地区，因此迫切需要建立有效的，