Dynamics of antimicrobial resistance and susceptibility profile in full-scale hospital wastewater treatment plants

Drug resistance has become a matter of great concern, with many bacteria now resist multiple antibiotics. This study depicts the occurrence of antibiotic-resistant bacteria (ARB) and resistance patterns in five full-scale hospital wastewater treatment plants (WWTPs). Samples of raw influent wastewater, as well as pre- and post-disinfected effluents, were monitored for targeted ARB and resistance genes in September 2022 and February 2023. Shifts in resistance profiles of Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii antimicrobial-resistant indicators in the treated effluent compared to that in the raw wastewater were also worked out. Ceftazidime (6.78 × 10⁵ CFU/mL) and cefotaxime (6.14 × 10⁵ CFU/mL) resistant species showed the highest concentrations followed by ciprofloxacin (6.29 × 10⁴ CFU/mL), and gentamicin (4.88 × 10⁴ CFU/mL), in raw influent respectively. WWTP-D employing a combination of biological treatment and coagulation/clarification for wastewater decontamination showed promising results for reducing ARB emissions from wastewater. Relationships between treated effluent quality parameters and ARB loadings showed that high BOD₅ and nitrate levels were possibly contributing to the persistence and/or selection of ARBs in WWTPs. Furthermore, antimicrobial susceptibility tests of targeted species revealed dynamic shifts in resistance profiles through treatment processes, highlighting the potential for ARB and ARGs in hospital wastewater to persist or amplify during treatment.