Wastewater Metagenomics for Antimicrobial Resistance and Pathogen Surveillance: A Bibliometric Analysis

Wastewater systems are critical reservoirs where antibiotic resistance genes, antibiotic-resistant bacteria, and pathogens converge and disseminate into receiving waters, posing risks to ecosystems and public health. Metagenomics enables culture-independent surveillance of resistome and pathogens in wastewater. After the COVID-19 pandemic, the rapid expansion of wastewater-based epidemiological surveillance, together with growing emphasis on the One Health framework, has further promoted the integration of wastewater metagenomic monitoring with public-health surveillance strategies. However, no bibliometric study has systematically mapped the global research landscape at the intersection of metagenomics, wastewater systems, antimicrobial resistance, and pathogen surveillance. This study retrieved 1161 publications from the Web of Science Core Collection and used CiteSpace to conduct bibliometric analyses. From 2010 to 2025, annual publications increased from 1 to 219, with 72.7% of the total output concentrated between 2021 and 2025. China led in publication output but showed low betweenness centrality, whereas Australia and Sweden served as key intermediaries. Keyword analysis revealed a gradual thematic evolution from the basic detection of antibiotic resistance genes in activated sludge, through studies of dissemination mechanisms, to recent work on One Health and wastewater surveillance. Literature co-citation analysis showed that integration between environmental monitoring and public health literature remains limited, suggesting that the translation of metagenomic surveillance data into health risk assessment frameworks is still at an early stage. By mapping the field's knowledge structure and gaps, this review highlights priorities for advancing wastewater-based Antimicrobial Resistance surveillance, including standardizing analytical methods, developing artificial intelligence-assisted resistome analysis, promoting equitable participation from underrepresented regions, and operationalizing One Health surveillance, thereby supporting the translation of wastewater monitoring into actionable public-health solutions.