What leaves the hospitals can be contained: a China-wide resistome study reveals limited impact of hospitals on adjacent surface waters

Le résumé fourni par la source

The frequent occurrence of bacteria, particularly human pathogens, carrying antibiotic resistance genes (ARGs) has become the norm rather than the exception. This is primarily due to decades of selective pressure, which has driven the widespread dissemination of ARGs across humans, animals, and the environment. Among transmission pathways, wastewater-polluted surface waters are notorious for spreading ARGs. Especially, water bodies near hospitals are more likely to receive hospital-derived ARGs in the absence of proper wastewater management. Resistome surveillance of hospital-adjacent surface waters can provide a basis for understanding and managing the hospital environment's ARG transmission chain. In this study, water samples were collected from hospital-adjacent surface waters in 11 cities across China. Results were compared with metagenomic data from rivers in other regions, including Nepal, Hong Kong, South Korea, and Switzerland. Resistomes of hospital-adjacent surface waters varied significantly across the studied Chinese cities; Shenzhen exhibited the highest ARG abundance. While ARG diversity differed across sites, similar core ARG types accounted for > 96% of total ARG abundance in each sample. Through extensive comparisons of regions, sampling locations, and hospital characteristics, we found that proximity to hospitals did not significantly influence resistome profiles in Chinese surface waters, where geographical factors were the primary drivers of ARG distribution. In contrast, rivers near hospitals in Nepal—a country with likely inadequate wastewater management—showed substantially elevated ARG levels. These findings demonstrate that, in the studied Chinese cities, with adequate infrastructure and policy-driven management, the environmental impact of hospital wastewater has been substantially mitigated. These results provide a critical framework for guiding the development of infrastructure and subsequent policies for managing hospital wastewater in low- and middle-income countries.

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