Risk assessment of the spread of antibiotic resistance genes from hospitals to the receiving environment via wastewater treatment plants

Antibiotics and antibiotic resistance genes (ARGs) enter the receiving environment from hospitals through wastewater treatment plants (WWTPs), increasing the presence of exogenous ARGs and conditional pathogens in the receiving environment, thereby elevating the risk of drug resistance. This study, based on metagenomics, investigated changes in risk across each node in the ARG transmission chain, from hospitals through WWTPs to downstream receiving water and sediments. The results showed that the total concentration of antibiotics decreased from 1467.80 ± 215.30 µg/L in hospital wastewater to 111.52 ± 18.70 µg/L in downstream receiving water, achieving a 92.40 % removal rate. However, the types of high ecological risk antibiotics in hospital wastewater were only reduced by 38.46 % after treatment by hospitals and sewage treatment plants. The abundance of Rank I ARGs was reduced by 37.03 % in hospital sewage treatment stations and 28.57 % in WWTPs, but these ARGs accounted for 81.8 % of the Rank I ARGs in receiving water. The potential host bacteria for these ARGs were mainly Proteobacteria, which carried bacitracin and multidrug resistance genes. While WWTPs removed 66.67 % of the conditional pathogens, bacteria such as Acinetobacter and Streptococcus still entered the receiving water. MetaCompare revealed that the potential transmission risk of ARGs decreased by 24.31 % after hospital wastewater treatment and by 20.71 % after WWTPs, with the risk of the receiving water being 7.01 times that in sediments. The potential risk assessment framework developed in this study for antibiotics and ARGs in the environment provides a theoretical guidance for antibiotic treatment and ARGs environmental risk control.