**5. Conclusions**

We found similar and widespread antibiotic resistance, co-resistance, MDR, and their genetic make-up in commensal bacteria from humans and their environment. The percentage of antibiotic resistance is higher in humans than in the environment, but the load (number of resistant isolates/sample) is higher in the environment than in humans. The study, thus, raises a number of important public health concerns. Firstly, community-based studies should be conducted to quantify attributes of antibiotic resistance to design an effective stewardship program; secondly, there should be a multi-sectorial national alliance with all key stakeholders to discourage non-therapeutic use of antibiotics; and, lastly, a strengthening of antimicrobial policy and antibiotic stewardship in India.

**Acknowledgments:** This study is a part of Swedish Research Council project number K2013-70X-20514-07-5. We extend our sincere thanks to the medical director, V.K. Mahadik, and the management of R.D. Gardi Medical College for facilitating this study. We are grateful for the excellent data collection and support in the field offered by Vivek Parashar and Shweta Khare and their team.

**Author Contributions:** All authors were involved in the conceptualization and design of the study. Manju Raj Purohit initiated the formulation of the study, responsible for the microbiological and molecular work and analyses, preparation of the manuscript, coordinated, and drafted the first version of the manuscript. Salesh Chandran was involved in the microbiological and molecular work, Harshada Shah was microbiology advisor, Vishal Diwan was responsible for data collection, and Ashok J Tamhankar was senior advisor for the environmental part. All authors have given intellectual input in the development of the manuscript, read, and approved the final version of the manuscript. Cecilia Stålsby Lundborg is the principle investigator of the project to which this study belongs.

**Conflicts of Interest:** The authors declare that they have no competing interests.
