Metagenomics unveils the role of hospitals and wastewater treatment plants on the environmental burden of antibiotic resistance genes and opportunistic pathogens

The study explores the use of wastewater-based epidemiology (WBE) as an early warning system for assessing the burden of Antimicrobial Resistance (AMR) at the population level. The research involved collecting effluent from three large hospitals and treated and untreated wastewater from three community WWTPs. The results showed a higher abundance and diversity of ARGs in hospital wastewater than in WWTPs. ARGs causing resistance to clinically significant antibiotics were more prevalent in hospital effluents, while resistance genes associated with rifampicin and MLS were more common in WWTPs. The study also highlighted variability in ARG removal efficiencies across WWTPs. The study suggests routine WBE surveillance, improved wastewater treatment strategies, and hospital-level source control measures to mitigate AMR dissemination.