A peek into hospital poo: Tracking pathogens and antimicrobial resistance

AIM This study sought to track the profile of antimicrobial resistance (AMR) genes and pathogens present in hospital settings in Wales, UK, by employing wastewater-based epidemiology (WBE). BACKGROUND Hospitals are recognized as critical hotspots for the proliferation of pathogenic microbes and the rapid emergence and spread of AMR. The effluents discharged from these settings play a significant role in introducing these contaminants into surrounding ecosystems. Tracking the type and load of AMR and pathogens within hospital environments is crucial for informing policy decisions and implementing effective risk mitigation strategies METHODS Twenty-hour composite waste-water samples were collected from hospital outfall pipes using refrigerated autosamplers. These samples were analysed to detect AMR genes and pathogenic microbes via metagenomic sequencing on the Illumina Novaseq 6000 platform. The study also monitored for the presence of antibiotics in the hospital effluents using UPLC-MS/MS. RESULTS AMR genes conferring resistance towards aminoglycosides, beta lactams and macrolides were prevalent. A significant presence of bacterial and fungal pathogens was also noted. Notable spatial and temporal variations were observed in the distribution of these contaminants across the hospital sites. The analysis also showed variations in the relative concentrations of different antimicrobial compounds across the hospitals. CONCLUSIONS The results highlight the role of hospital wastewater as significant reservoirs for AMR genes, antibiotics, and pathogens into the environment. We strongly recommend the pre-treatment of these effluents on-site before their discharge into municipal wastewater treatment systems to mitigate these risks.