The human microbiome has been under antibiotic selection pressure for several decades - intense and transient in some environments and mild and persistent in others.

Restricted diversity in the transmissible antibiotic resistance gene pool is an opportunity that can be exploited for short-term translational opportunities (eg. rapid diagnosis of antibiotic resistance in E. coli and Klebsiella) but also hints at a scenario not unlike that of other ecosystems in which human impact has been extremely problematic, and which may include the  inevitable co-selection of various 'virulence' attributes, including ability to cause disease and to resist antibiotics. If an ecological 'tipping point' exists  beyond which natural biodiversity cannot be restored after antibiotic exposure, the risk is global in scale and potentially affects all species on the planet as much as our own.

Available data already provide an imperative for global policy discussions regarding husbandry of the human microbiome and a impart new urgency to clinical, translational and basic microbiology research in this area.