The Role of Water as a Reservoir for Antibiotic-Resistant Bacteria

Water systems serve as multifaceted environmental pools for antibiotic-resistant bacteria (ARB) and resistance genes (ARGs), influencing human, animal, and ecosystem health. This review synthesizes current understanding of how antibiotics, ARB, and ARGs enter surface, ground, and drinking waters via wastewater discharge, agricultural runoff, hospital effluents, and urban stormwater. We highlight key mechanisms of biofilm formation, horizontal gene transfer, and co-selection by chemical stressors that facilitate persistence and spread. Case studies illustrate widespread detection of clinically meaningful ARB (e.g., Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae) and mobile ARGs (e.g., sul1/2, tet, bla variants) in treated effluents, recycled water, and irrigation return flows. The interplay between treatment inefficiencies and environmental processes underscores the need for advanced treatment technologies, integrated monitoring, and policy interventions. Addressing these challenges is critical to curbing the environmental dissemination of resistance and protecting human and ecosystem health.