Metagenomic Meta-Analysis of Antibiotic-Resistance Genes in Wastewater: A Perspective from the COVID-19 Pandemic

Antibiotic resistance is a silent global crisis intensified by the recent pandemic of coronavirus disease 2019 (COVID-19). To address this growing threat, wastewater-based surveillance (WBS) is emerging as a promising public health tool for monitoring antibiotic resistance within communities. Our meta-analysis aims to reveal the landscape of antibiotic-resistance genes (ARGs) in global wastewater during and after the COVID-19 pandemic. The analysis included wastewater samples collected between 2020 and 2024 from five countries across three continents: Asia (China), Europe (United Kingdom and Russia), and North America (United States and Canada). Our findings showed higher observed ARGs in Russia and China despite their small sample size, while the USA showed more diverse ARGs. Distinct patterns of ARGs were observed in European and North American wastewater samples (p-value < 0.001). We identified 2483 ARGs, with multidrug-resistant (MDR) genes dominating most regions and accounting for almost 45% of all ARGs detected in Europe. Country-specific indicator ARGs showed 22 unique ARGs for Russia, 3 for each of the UK and Canada, and 2 were specific for China. Continentally, 100 indicator ARGs were specific to Asia, 38 to Europe, and 18 to North America. These findings highlight the regional variations in ARG profiles, emphasizing the urgent need for region-specific strategies to combat antibiotic-resistance threat. Additionally, our study further supports the value of WBS as a valuable public health tool for monitoring antibiotic resistance.