Impact of Hospital Wastewater on the Spread of Antimicrobial Resistance Genes

Abstract

Antimicrobial resistance (AMR) has emerged as a major global health threat, with environmental dissemination of resistance genes posing a critical challenge. Hospital wastewater has been increasingly recognized as a significant reservoir and transmission route for antimicrobial resistance genes (ARGs) due to its complex composition, including high concentrations of antibiotics, disinfectants, and resistant pathogens. This paper explores the multifaceted role of hospital effluents in promoting the selection, amplification, and dissemination of ARGs into the environment. It examines the mechanisms of horizontal gene transfer, the involvement of mobile genetic elements, and the contribution of biofilms in enhancing resistance propagation. Advanced detection techniques such as qPCR and metagenomic sequencing are discussed in the context of monitoring ARG prevalence. The environmental and public health implications of untreated or inadequately treated hospital wastewater are highlighted, including contamination of natural ecosystems and potential exposure to resistant bacteria. Current mitigation strategies, such as on-site pre-treatment and advanced filtration technologies, are evaluated alongside policy and regulatory measures. The paper concludes by identifying key research gaps and advocating for a holistic One Health approach that integrates environmental monitoring, technological innovation, and global cooperation to effectively curb the environmental spread of AMR from hospital sources.