Abstract
Background: Healthcare settings are recognised as potential hotspots for the
emergence and spread of antimicrobial resistance (AMR).
Method: Metagenomic sequencing was conducted on a national scale using
wastewater from hospitals across Wales to screen for antimicrobial resistance genes
(ARGs) and opportunistic pathogens.
Results: The total abundance and diversity of ARGs varied significantly across the
hospitals. Genes conferring resistance to aminoglycosides, beta-lactams, and MLSclass antibiotics were predominant, with distinct resistome patterns emerging spatially. OXA-type beta-lactamases were the dominant ARG types. Spatial variability was observed in the distribution of the "big five" carbapenemases (KPC, IMP, VIM, NDM, OXA-48-like) and mcr genes, as well as WHO-listed fungal priority pathogens and ESKAPEE pathogens. Furthermore, antibiotic concentrations in the effluents often
exceeded risk quotients, posing a substantial risk for AMR emergence.
Conclusions: Overall, the study highlights the effectiveness of combining wastewater-based epidemiology with metagenomics to gain critical insights into the distinct
resistome and microbiome profiles in hospital settings. Tailored strategies are essential to mitigate the spread of antibiotics, clinically relevant ARGs and pathogens in these settings. This study underscores the necessity of implementing pre-treatment
processes for hospital effluents before release into community sewers and
environmental waters to curb the spread of these micro-pollutants.
emergence and spread of antimicrobial resistance (AMR).
Method: Metagenomic sequencing was conducted on a national scale using
wastewater from hospitals across Wales to screen for antimicrobial resistance genes
(ARGs) and opportunistic pathogens.
Results: The total abundance and diversity of ARGs varied significantly across the
hospitals. Genes conferring resistance to aminoglycosides, beta-lactams, and MLSclass antibiotics were predominant, with distinct resistome patterns emerging spatially. OXA-type beta-lactamases were the dominant ARG types. Spatial variability was observed in the distribution of the "big five" carbapenemases (KPC, IMP, VIM, NDM, OXA-48-like) and mcr genes, as well as WHO-listed fungal priority pathogens and ESKAPEE pathogens. Furthermore, antibiotic concentrations in the effluents often
exceeded risk quotients, posing a substantial risk for AMR emergence.
Conclusions: Overall, the study highlights the effectiveness of combining wastewater-based epidemiology with metagenomics to gain critical insights into the distinct
resistome and microbiome profiles in hospital settings. Tailored strategies are essential to mitigate the spread of antibiotics, clinically relevant ARGs and pathogens in these settings. This study underscores the necessity of implementing pre-treatment
processes for hospital effluents before release into community sewers and
environmental waters to curb the spread of these micro-pollutants.
| Original language | English |
|---|---|
| Article number | 106503 |
| Journal | Journal of Infection |
| Volume | 90 |
| Issue number | 6 |
| Early online date | 12 May 2025 |
| DOIs | |
| Publication status | Published - 30 Jun 2025 |
Data Availability Statement
The data will be made available upon request.Acknowledgements
This work would not have been possible without the help of the estate departments at the eight hospitals evaluated in this study, the Health Boards, and the support of Robin Howe from Public Health Wales. The graphical abstract was created with BioRender.com.Funding
The project was funded by the HM Treasury Shared Outcome Fund under the Pathogen Surveillance in Agriculture, Food and Environment (PATH-SAFE) program Workstream 2a, the Welsh Government under the Wastewater Monitoring Programme in Wales programme (Contract Number C525/2021-2024) and EPSRC Digital Health Hub for Antimicrobial Resistance Grant (EP/X031276/1).