Toggle Main Menu Toggle Search

Open Access padlockePrints

Comparison of antibiotic-resistant bacteria and antibiotic resistance genes abundance in hospital and community wastewater: A systematic review

Lookup NU author(s): Professor David Graham


Full text for this publication is not currently held within this repository. Alternative links are provided below where available.


Antibiotic-resistant bacteria (ARB) and antibiotic-resistance genes (ARGs) are constantly shed into the aquatic environment, with hospital wastewater potentially acting as an important source for resistance spread into the environment. A systematic review was conducted aiming to investigate the role of hospital wastewater on dissemination of antimicrobial resistance in the aquatic environment. Studies included in the review compared the prevalence of ARB and/or ARGs in hospital versus community wastewater. Data were extracted on ARB and/or ARG prevalence. Data on sampling techniques, microbiological methodology and risk of bias of included studies were recorded.Thirty-seven studies were included. Higher frequencies of antibiotic resistance determinants were found in hospital wastewater compared to community sources in 30/37 (81%) of included studies. However, trends for specific multi-drug-resistant bacteria differed. Antibiotic-resistant Gram-negative were more prevalent in hospital compared to community wastewaters, with higher concentrations of extended-spectrum-beta-lactamase-producing pathogens and carbapenemase-producing Enterobacteriaceae in hospital sources in 9/9 studies and 6/7 studies, respectively. Hospitals did not contribute consistently to the abundance of vancomycin-resistant Enterococci (VRE); 5/10 studies found higher abundance of VRE in hospital compared to community wastewaters. Reporting on sampling methods, wastewater treatment processes and statistical analysis were at high risk of bias. Extreme heterogeneity in study methods and outcome reporting precluded meta-analysis.Current evidence concurs that hospital wastewater is an important source for antibiotic resistance in aquatic environments, mainly multidrug-resistant Gram-negative bacteria. Future research is needed to assess the effect of wastewater treatment processes on overall antibiotic resistance in the aquatic environment.

Publication metadata

Author(s): Hassoun-Kheir N, Stabholtz Y, Kreft J-U, de la Cruz R, Romalde JL, Nesme J, Sørensen SJ, Smets BF, Graham DW, Paul M

Publication type: Review

Publication status: Published

Journal: Science of the Total Environment

Year: 2020

Volume: 743

Print publication date: 15/11/2020

Online publication date: 11/07/2020

Acceptance date: 05/07/2020

ISSN (print): 0048-9697

ISSN (electronic): 1879-1026

Publisher: Elsevier


DOI: 10.1016/j.scitotenv.2020.140804


Find at Newcastle University icon    Link to this publication