摘要
      细菌病原体和抗生素耐药性基因（ARGs）通过医院废水（HWW）广泛传播到环境中，因为废水中含有大量住院患者的粪便。然而，对医院污水处理厂（hWWTP）住院患者肠道中抗生素耐药性和致病菌的研究有限。在这里，我们检查并比较了典型的hWWTP系统中患者粪便中ARGs、可移动遗传元素（MGE）、金属和细菌群落的发生率和丰度，并确定了负责转移ARGs的致病宿主。在住院患者的粪便中检测到176个ARGs和43个MGE，129个基因是持久性的，88个基因在HWW治疗后富集，特别是对于blaVEB、blaNDM和1类整合素（intI1），平均富集度分别为659倍、202倍和7倍。住院患者粪便中的MGE，尤其是Is613，异常丰富，甚至超过了总ARGs的丰度，这解释了由于可能的基因动员事件，ARGs在hWWTP中的持续存在。拟杆菌门和厚壁菌门是这些粪便中最丰富的门，占肠道总微生物群的81%，而Epsilonbacteraeota和Proteobacteria在hWWTP中占主导地位。此外，在医院环境中发现54种可能的细菌病原体，包括4种“ESKAPE”病原体和14种癌症相关病原体。其中许多与不同类型的ARG密切相关。值得注意的是，通过网络分析确定，拟杆菌是主要的潜在ARG致病属，并且在治疗后非常丰富。微生物群落的改变是形成抗生素耐药性的主要因素。这项研究可能会对整个HWW治疗系统中住院患者肠道中ARGs和病原体的分布情况提供全面的了解，可作为优化HWW治疗和监测公共风险的参考。
Abstract
Bacterial pathogens and antibiotic resistance genes (ARGs) are extensively disseminated into the environment via hospital wastewater (HWW), as it contains large quantities of feces from resident patients. However, studies on the antibiotic resistome and pathogenic bacteria from the gut of resident patients within the hospital wastewater treatment plant (hWWTP) are limited. Here, we examined and compared the occurrence and abundance of ARGs, mobile genetic elements (MGEs), metals, and bacterial communities from the feces of patients in a typical hWWTP system and determined the pathogenic hosts responsible for transferring ARGs. There were 176 ARGs and 43 MGEs detected in the feces of hospitalized patients, 129 genes were persistent, and 88 genes were enriched after HWW treatment, particularly for the blaVEB, blaNDM, and class 1 integron (intI1), with an average of 659-fold, 202-fold, and seven-fold enrichment, respectively. MGEs, especially Is613, in the feces of hospitalized patients were exceptionally abundant and even surpassed the abundance of total ARGs, which explained the persistence of ARGs in hWWTPs due to possible gene mobilization events. Bacteroidetes and Firmicutes were the most abundant phyla in these feces, accounting for 81 % of the total gut microbiota, while Epsilonbacteraeota and Proteobacteria dominated the hWWTPs. Additionally, 54 possible bacterial pathogens were found in the hospital environment, including four “ESKAPE” pathogens and 14 cancer-related pathogens. Many of them were strongly associated with different types of ARGs. Notably, Bacteroides was the major potential ARG-harboring pathogenic genus, as determined by the network analysis, and was highly abundant after the treatment. The altered microbial community was the major contributing factor shaping antibiotic resistome. This study might provide a comprehensive insight into the distribution profiles of ARGs and pathogens from the gut of inpatients throughout the HWW treatment system, which could be used as a reference for optimizing HWW treatment and monitoring public risk.

https://www.sciencedirect.com/science/article/abs/pii/S0048969722070073