Hospital wastewater as a hotspot for antibiotic-resistant bacteria and emerging pollutants: A focused systematic review

In the hospital's wastewater, there are groups of un-metabolised and metabolised drugs with disinfectants and diagnostic agents as well as pathogen, ARB, ARGs, and MGEs. Multiple hazards which are occurring will bring about selection, gene transfer and dissemination. Aim of the study: In this paper, we discuss original experimental data published so far (2015 to 15 July 2023) on the joint occurrence, selection, mobility and treatment of ARB/ARGs and emerging chemical pollutants in hospital wastewater. With this, we hope to verify whether the problem of hospital wastewater has reached a stage of crisis like urban wastewater.  The study was specifically designed based on PubMed/Europe PMC and publisher/Crossref verification, with Scopus and Web of Science strings supplied for author rerunning before submission. This study was carried out a priori, meaning that it was performed before the actual investigation. Intended to be a focused systematic review, in accordance with PRISMA 2020. According to the study, hospital wastewater was directly sampled in eligible studies and a minimum of two linked domains were reported. For instance, antimicrobial or pharmaceutical residues; phenotypic ARB; ARGs/MGEs; metagenomic hosts; or biological-chemical treatment performance. As many as ten original studies conducted in Asia, Europe and South America met the deliberately stringent evidence-integration criteria. Results were synthesized narratively and by direction of effect rather than pooled statistically as endpoints, denominators and treatment configurations were heterogeneous. Results of the study found in untreated hospital wastewater antibiotic concentrations at ng/L to µg/L scales, diverse multi-drug resistant organisms and clinically important genes. High-priority signals included gene associated with resistance to beta-lactams, sulfonamide, and quinolone, vanA, and intI1. A study proved selecting drug-resistant E. coli is possible (9 words) This shows ciprofloxacin and beta-lactams may be tested for selective agents in E. coli. Effluent and influent studies showed incomplete removal with conventional treatment. In an opposite manner, the on-site improvement of industrial trains as well as plant-scale ozonation reduced chemical and biological hazards although DNA-based signals and ozone-tolerant survivors continued to be relevant. Based on our analysis, we conclude that hospital wastewater should be regarded as a coupled chemical–biological hotspot, not merely as a pathogen source. Risk management efforts should favour surveillance of the hospital environment, source control in high-risk wards, and multi-barrier treatment with double validation against antibiotic residues, viable ARB, intracellular and extracellular ARGs, MGEs and ecotoxicological endpoints. The protocol was not registered in advance but should be deposited before submission in a version with a date