Comprehensive Review on the Distribution, Environmental Fate, and Risks of Antibiotic Resistance Genes in Rivers and Lakes of China

Antibiotic resistance genes (ARGs) have emerged as globally concerning environmental contaminants, posing serious threats to ecosystem health and public safety. This systematic review summarizes global research trends on ARGs across three key aspects: (i) identification and distribution in river and lake ecosystems, (ii) sources and environmental behaviors, and (iii) ecological and human health risks. Concentration data of ARGs in various rivers and lakes across China were compiled to reveal their spatial distribution patterns. The analysis of ARGs sources and environmental behaviors provides essential insights for designing effective mitigation strategies. Furthermore, this review highlights the potential ecological and human health hazards of ARGs and discusses limitations and improvement directions of current risk assessment methodologies. The main findings indicate that ARGs are widely present in rivers and lakes across China; higher abundances occur in eastern and southern regions compared with central–western and northern areas, such as 4.93 × 102–8.10 × 103 copies/mL in Qinghai Lake and 6.7 × 107–1.76 × 108 copies/mL in Taihu Lake. The environmental behaviors of ARGs are highly complex, involving multiple mechanisms and influenced by climatic conditions, nutrient levels, and additional environmental factors. Based on these findings, future efforts should prioritize long-term site-specific monitoring, evaluate their prolonged impacts on aquatic ecosystems, and develop integrated risk assessment models to support evidence-based environmental management.