Antibiotic and Non-Antibiotic Determinants of Antimicrobial Resistance: Insights from Water Ecosystems

Antibiotic resistance is a matter of global concern, casting a shadow over both public well-being and environmental equilibrium. While overuse of antibiotics was initially believed to be the primary driving factor, it is now evident that non-antibiotic agents such as heavy metals, biocides, endocrine-disrupting chemicals, and microplastics, often overlooked, could also be contributing to this central problem. Within water systems, wastewater treatment plants (WWTPs) are recognized for harboring antibiotic-resistant bacteria (ARB) and antimicrobial resistance genes (ARGs) and greatly impacted with anthropogenic pollutants, making them hotspots for antimicrobial resistance (AMR). This review explains the AMR resistome and how it spreads with mobile genetic elements (MGEs), highlighting the impact of antibiotics and non-antibiotic agents on AMR emergence, covering the presence of ARGs and MGEs in water systems, and exploring advanced technologies for WWTPs to mitigate the issue, emphasizing water environments’ critical role in the One Health framework.