Influence of hospital wastewater on the development of antimicrobial resistance

Resistance to antimicrobial agents is a developing issue that requires calls for an integrated strategy from all nations. A significant contributor to antimicrobial resistance (AMR) is wastewater that is a vital resource for bacteria which provides a medium for gene transfer. Stressors like high concentration of hydrogen ions, antibiotics, and minerals can start and spread AMR in wastewater. Antimicrobial agents are present in the environment in varying amounts depending on the antimicrobial class and their frequent use. Evolution of antibiotic-resistant bacteria (ARB) poses a significant public health risk; especially in healthcare facilities and hospital’s wastewater. Advanced wastewater treatment technologies should be implemented for effective treatment of hospital wastewater (HWW). Standardized phenotypic approaches are used to detect AMR in bacteria. Molecular approaches are now preferred to be used in laboratories instead of phenotypic approaches as they are faster and more accurate for detection of AMR's underlying genetic mechanisms. The most common molecular approaches for assessing AMR in water include quantitative polymerase chain reaction (PCR) and whole genome sequencing (WGS). Metagenomic WGS sequencing provides more extensive genomic data and taxonomic classification than quantitative PCR, as it makes sequencing for the entire genome of microorganisms. The objectives of this review were to demonstrate the primary mechanisms through which bacteria develop resistance to antimicrobials in water, and investigate the impact of hospital effluent water on the spread AMR and ARB. Additionally, various approaches for assessing AMR levels and guidelines for preventing and managing the transmission of AMR to the environment were discussed.