{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T23:08:43Z","timestamp":1793660923323,"version":"4.5.1"},"reference-count":79,"publisher":"Elsevier BV","issue":"6","license":[{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T00:00:00Z","timestamp":1746316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014609","name":"Public Health Wales","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014609","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015846","name":"Welsh Government","doi-asserted-by":"publisher","award":["C525\/2021-2024"],"award-info":[{"award-number":["C525\/2021-2024"]}],"id":[{"id":"10.13039\/100015846","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","award":["EP\/X031276\/1"],"award-info":[{"award-number":["EP\/X031276\/1"]}],"id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005624","name":"PATH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005624","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000354","name":"Food Standards Agency","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000354","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","journalofinfection.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Infection"],"published-print":{"date-parts":[[2025,6]]},"DOI":"10.1016\/j.jinf.2025.106503","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T19:03:16Z","timestamp":1747076596000},"page":"106503","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":40,"title":["Metagenomic profiling of hospital wastewater: A comprehensive national scale analysis of antimicrobial resistance genes and opportunistic pathogens"],"prefix":"10.1016","volume":"90","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6182-6031","authenticated-orcid":false,"given":"Reshma","family":"Silvester","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9596-3333","authenticated-orcid":false,"given":"William B.","family":"Perry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9530-7835","authenticated-orcid":false,"given":"Gordon","family":"Webster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rushton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Baldwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Pass","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3303-5360","authenticated-orcid":false,"given":"Neil Andrew","family":"Byrnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7068-3228","authenticated-orcid":false,"given":"Kata","family":"Farkas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Heginbothom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Craine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth","family":"Cross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kille","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Kasprzyk-Hordern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6671-2209","authenticated-orcid":false,"given":"Andrew J.","family":"Weightman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1482-4209","authenticated-orcid":false,"given":"Davey L.","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"6","key":"10.1016\/j.jinf.2025.106503_bib1","doi-asserted-by":"crossref","first-page":"e619","DOI":"10.1016\/S2214-109X(18)30186-4","article-title":"Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey","volume":"6","author":"Versporten","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"12","key":"10.1016\/j.jinf.2025.106503_bib2","doi-asserted-by":"crossref","first-page":"e368","DOI":"10.1016\/S1473-3099(18)30296-2","article-title":"Quantifying drivers of antibiotic resistance in humans: a systematic review","volume":"18","author":"Chatterjee","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"9","key":"10.1016\/j.jinf.2025.106503_bib3","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/S1473-3099(09)70150-1","article-title":"Rapid screening tests for meticillin-resistant Staphylococcus aureus at hospital admission: systematic review and meta-analysis","volume":"9","author":"Tacconelli","year":"2009","journal-title":"Lancet Infect Dis"},{"issue":"36","key":"10.1016\/j.jinf.2025.106503_bib4","doi-asserted-by":"crossref","first-page":"13285","DOI":"10.1073\/pnas.0402298101","article-title":"Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals","volume":"101","author":"Bergstrom","year":"2004","journal-title":"Proc Natl Acad Sci"},{"issue":"4","key":"10.1016\/j.jinf.2025.106503_bib5","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.jhin.2016.01.010","article-title":"What happens in hospitals does not stay in hospitals: antibiotic-resistant bacteria in hospital wastewater systems","volume":"93","author":"Hocquet","year":"2016","journal-title":"J Hosp Infect"},{"issue":"2","key":"10.1016\/j.jinf.2025.106503_bib6","doi-asserted-by":"crossref","DOI":"10.1016\/j.jece.2020.104812","article-title":"A review on hospital wastewater treatment: A special emphasis on occurrence and removal of pharmaceutically active compounds, resistant microorganisms, and SARS-CoV-2","volume":"9","author":"Majumder","year":"2021","journal-title":"J Environ Chem Eng"},{"key":"10.1016\/j.jinf.2025.106503_bib7","article-title":"Addressing the challenges of combined sewer overflows","volume":"2023","author":"Perry","year":"2015","journal-title":"Environ Pollut"},{"issue":"2","key":"10.1016\/j.jinf.2025.106503_bib8","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1038\/s41576-023-00649-y","article-title":"Genomic surveillance for antimicrobial resistance \u2014 a One Health perspective","volume":"25","author":"Djordjevic","year":"2024","journal-title":"Nat Rev Genet"},{"key":"10.1016\/j.jinf.2025.106503_bib9","doi-asserted-by":"crossref","DOI":"10.1016\/j.jwpe.2021.101990","article-title":"Hospital wastewater as a source of environmental contamination: An overview of management practices, environmental risks, and treatment processes","volume":"41","author":"Khan","year":"2021","journal-title":"J Water Process Eng"},{"key":"10.1016\/j.jinf.2025.106503_bib10","doi-asserted-by":"crossref","DOI":"10.1016\/j.envpol.2023.122020","article-title":"Antimicrobials and antimicrobial resistance genes in a one-year city metabolism longitudinal study using wastewater-based epidemiology","volume":"333","author":"Sims","year":"2023","journal-title":"Environ Pollut"},{"issue":"7","key":"10.1016\/j.jinf.2025.106503_bib11","doi-asserted-by":"crossref","first-page":"10785","DOI":"10.1007\/s11356-024-31829-w","article-title":"Effectiveness of wastewater treatment plant at the removal of nutrients, pathogenic bacteria, and antibiotic-resistant bacteria in wastewater from hospital source","volume":"31","author":"Owojori","year":"2024","journal-title":"Environ Sci Pollut Res"},{"key":"10.1016\/j.jinf.2025.106503_bib12","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2021.703560","article-title":"Secrets of the hospital underbelly: patterns of abundance of antimicrobial resistance genes in hospital wastewater vary by specific antimicrobial and bacterial family","volume":"12","author":"Perry","year":"2021","journal-title":"Front Microbiol"},{"key":"10.1016\/j.jinf.2025.106503_bib13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13073-020-00782-x","article-title":"Understanding the impact of antibiotic perturbation on the human microbiome","volume":"12","author":"Schwartz","year":"2020","journal-title":"Genome Med"},{"key":"10.1016\/j.jinf.2025.106503_bib14","doi-asserted-by":"crossref","DOI":"10.1016\/j.scitotenv.2023.168453","article-title":"Multidrug antibiotic resistance in hospital wastewater as a reflection of antibiotic prescription and infection cases","volume":"908","author":"Siri","year":"2024","journal-title":"Sci Total Environ"},{"key":"10.1016\/j.jinf.2025.106503_bib15","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2022.942460","article-title":"A comparison of the composition and functions of the oral and gut microbiotas in Alzheimer\u2019s patients","volume":"12","author":"Chen","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"10.1016\/j.jinf.2025.106503_bib16","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijheh.2024.114379","article-title":"Small-scale wastewater-based epidemiology (WBE) for infectious diseases and antibiotic resistance: A scoping review","volume":"259","author":"Schmiege","year":"2024","journal-title":"Int J Hyg Environ Health"},{"issue":"6","key":"10.1016\/j.jinf.2025.106503_bib17","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1093\/jac\/dkx017","article-title":"Overexpression of antibiotic resistance genes in hospital effluents over time","volume":"72","author":"Rowe","year":"2017","journal-title":"J Antimicrob Chemother"},{"issue":"2","key":"10.1016\/j.jinf.2025.106503_bib18","doi-asserted-by":"crossref","DOI":"10.1128\/spectrum.04102-22","article-title":"Metagenomic insight into microbiome and antibiotic resistance genes of high clinical concern in urban and rural hospital wastewater of northern India origin: a major reservoir of antimicrobial resistance","volume":"11","author":"Talat","year":"2023","journal-title":"Microbiol Spectr"},{"key":"10.1016\/j.jinf.2025.106503_bib19","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2020.574968","article-title":"Hospital wastewater as a reservoir for antibiotic resistance genes: a meta-analysis","volume":"8","author":"Zhang","year":"2020","journal-title":"Front Public Health"},{"issue":"1","key":"10.1016\/j.jinf.2025.106503_bib20","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S0167-7012(03)00140-4","article-title":"Assessment of bacterial community structure in the deep sub-seafloor biosphere by 16S rDNA-based techniques: a cautionary tale","volume":"55","author":"Webster","year":"2003","journal-title":"J Microbiol Methods"},{"key":"10.1016\/j.jinf.2025.106503_bib21","doi-asserted-by":"crossref","DOI":"10.1016\/j.scitotenv.2025.178403","article-title":"Metagenomics unveils the role of hospitals and wastewater treatment plants on the environmental burden of antibiotic resistance genes and opportunistic pathogens","volume":"961","author":"Silvester","year":"2025","journal-title":"Sci Total Environ"},{"issue":"19","key":"10.1016\/j.jinf.2025.106503_bib22","doi-asserted-by":"crossref","first-page":"3047","DOI":"10.1093\/bioinformatics\/btw354","article-title":"MultiQC: summarize analysis results for multiple tools and samples in a single report","volume":"32","author":"Ewels","year":"2016","journal-title":"Bioinformatics"},{"issue":"2","key":"10.1016\/j.jinf.2025.106503_bib23","doi-asserted-by":"crossref","DOI":"10.1093\/gigascience\/giab008","article-title":"Twelve years of SAMtools and BCFtools","volume":"10","author":"Danecek","year":"2021","journal-title":"Gigascience"},{"issue":"4","key":"10.1016\/j.jinf.2025.106503_bib24","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1038\/nmeth.1923","article-title":"Fast gapped-read alignment with Bowtie 2","volume":"9","author":"Langmead","year":"2012","journal-title":"Nat Methods"},{"issue":"4","key":"10.1016\/j.jinf.2025.106503_bib25","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1038\/nbt.3820","article-title":"Nextflow enables reproducible computational workflows","volume":"35","author":"Di Tommaso","year":"2017","journal-title":"Nat Biotechnol"},{"issue":"D1","key":"10.1016\/j.jinf.2025.106503_bib26","doi-asserted-by":"crossref","first-page":"D744","DOI":"10.1093\/nar\/gkac1047","article-title":"MEGARes and AMR++, v3. 0: an updated comprehensive database of antimicrobial resistance determinants and an improved software pipeline for classification using high-throughput sequencing","volume":"51","author":"Bonin","year":"2023","journal-title":"Nucleic Acids Res"},{"key":"10.1016\/j.jinf.2025.106503_bib27","doi-asserted-by":"crossref","DOI":"10.7717\/peerj-cs.104","article-title":"Bracken: estimating species abundance in metagenomics data","volume":"3","author":"Lu","year":"2017","journal-title":"PeerJ Comput Sci"},{"issue":"26","key":"10.1016\/j.jinf.2025.106503_bib28","doi-asserted-by":"crossref","first-page":"9713","DOI":"10.1021\/acs.est.3c00159","article-title":"Toward a universal unit for quantification of antibiotic resistance genes in environmental samples","volume":"57","author":"Yin","year":"2023","journal-title":"Environ Sci Technol"},{"key":"10.1016\/j.jinf.2025.106503_bib29","series-title":"ATC\/DDD Index 2023","year":"2003"},{"issue":"11","key":"10.1016\/j.jinf.2025.106503_bib30","doi-asserted-by":"crossref","first-page":"3384","DOI":"10.1093\/jac\/dkz321","article-title":"Adaptation of the WHO Essential Medicines List for national antibiotic stewardship policy in England: being AWaRe","volume":"74","author":"Budd","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"10.1016\/j.jinf.2025.106503_bib31","article-title":"Assessing the risk of antimicrobial resistance and environmental harm through national-scale surveillance of antimicrobials in hospital and community wastewater","author":"Byrnes","year":"2024","journal-title":"Environ Int"},{"issue":"2","key":"10.1016\/j.jinf.2025.106503_bib32","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1093\/bioinformatics\/btg412","article-title":"APE: analyses of phylogenetics and evolution in R language","volume":"20","author":"Paradis","year":"2004","journal-title":"Bioinformatics"},{"key":"10.1016\/j.jinf.2025.106503_bib33","first-page":"235","article-title":"Package \u2018hmisc\u2019","volume":"2019","author":"Harrell","year":"2019","journal-title":"CRAN2018"},{"key":"10.1016\/j.jinf.2025.106503_bib34","unstructured":"Csardi MG. Package \u2018igraph\u2019. 2013;\u00a03(09). https:\/\/igraph.org."},{"issue":"1","key":"10.1016\/j.jinf.2025.106503_bib35","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1609\/icwsm.v3i1.13937","article-title":"Gephi: an open source software for exploring and manipulating networks","volume":"3","author":"Bastian","year":"2009","journal-title":"Proc Int AAAI Conf Web Soc Media"},{"key":"10.1016\/j.jinf.2025.106503_bib36","series-title":"Critically important antimicrobials for human medicine: 6th revision 2018. Ranking of medically important antimicrobials for risk management of antimicrobial resistance due to non-human use","author":"WHO","year":"2018"},{"issue":"5","key":"10.1016\/j.jinf.2025.106503_bib37","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.molmed.2012.03.003","article-title":"Carbapenem resistance in Enterobacteriaceae: here is the storm!","volume":"18","author":"Nordmann","year":"2012","journal-title":"Trends Mol Med"},{"key":"10.1016\/j.jinf.2025.106503_bib38","series-title":"WHO fungal priority pathogens list to guide research, development, and public health action","author":"WHO","year":"2022"},{"key":"10.1016\/j.jinf.2025.106503_bib39","article-title":"Evidence for selection of multi-resistant E. coli by hospital effluent","volume":"150","author":"R\u00edos","year":"2021","journal-title":"Environ Int"},{"key":"10.1016\/j.jinf.2025.106503_bib40","doi-asserted-by":"crossref","DOI":"10.1016\/j.scitotenv.2023.165978","article-title":"Distinctive hospital and community resistomes in Scottish urban wastewater: Metagenomics of a paired wastewater sampling design","volume":"902","author":"Lepper","year":"2023","journal-title":"Sci Total Environ"},{"key":"10.1016\/j.jinf.2025.106503_bib41","series-title":"Antimicrobial Resistance in Urinary Coliforms Wales in 2016-2023 (Version 1)","author":"Healthcare Associated Infection, Antimicrobial Resistance and Prescribing Programme","year":"2023"},{"key":"10.1016\/j.jinf.2025.106503_bib42","series-title":"Antimicrobial Resistance in Blood Cultures Wales in 2016-2023 (Version 1)","author":"Healthcare Associated Infection, Antimicrobial Resistance and Prescribing Programme","year":"2023"},{"issue":"5","key":"10.1016\/j.jinf.2025.106503_bib43","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijantimicag.2022.106573","article-title":"High prevalence of colistin resistance and mcr-9\/10 genes in Enterobacter spp. in a tertiary hospital over a decade","volume":"59","author":"Liao","year":"2022","journal-title":"Int J Antimicrob Agents"},{"issue":"4","key":"10.1016\/j.jinf.2025.106503_bib44","doi-asserted-by":"crossref","DOI":"10.1128\/spectrum.01127-22","article-title":"First report of the colistin resistance gene mcr-10.1 carried by IncpA1763-KPC plasmid pSL12517-mcr10. 1 in Enterobacter cloacae in Sierra Leone","volume":"10","author":"Guan","year":"2022","journal-title":"Microbiol Spectr"},{"key":"10.1016\/j.jinf.2025.106503_bib45","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jgar.2024.10.260","article-title":"Study of the mechanisms of colistin heteroresistance in a strain of Enterobacter cloacae by random mutagenesis","volume":"39","author":"Milleville","year":"2024","journal-title":"J Glob Antimicrob Resist"},{"issue":"3","key":"10.1016\/j.jinf.2025.106503_bib46","doi-asserted-by":"crossref","first-page":"79","DOI":"10.4291\/wjgp.v6.i3.79","article-title":"Human microbiome: From the bathroom to the bedside","volume":"6","author":"Malnick","year":"2015","journal-title":"World J Gastrointest Pathophysiol"},{"key":"10.1016\/j.jinf.2025.106503_bib47","series-title":"WHO publishes list of bacteria for which new antibiotics are urgently needed","year":"2017"},{"issue":"10","key":"10.1016\/j.jinf.2025.106503_bib48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41579-024-01054-w","article-title":"ESKAPE pathogens: antimicrobial resistance, epidemiology, clinical impact and therapeutics","volume":"22","author":"Miller","year":"2024","journal-title":"Nat Rev Microbiol"},{"key":"10.1016\/j.jinf.2025.106503_bib49","doi-asserted-by":"crossref","DOI":"10.3389\/fenvs.2022.1091734","article-title":"Hospital wastewater as hotspots for pathogenic microorganisms spread into aquatic environment: a review","volume":"10","author":"Yuan","year":"2023","journal-title":"Front Environ Sci"},{"issue":"2","key":"10.1016\/j.jinf.2025.106503_bib50","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/CMR.00111-18","article-title":"Candida parapsilosis: from Genes to the Bedside","volume":"32","author":"T\u00f3th","year":"2019","journal-title":"Clin Microbiol Rev"},{"key":"10.1016\/j.jinf.2025.106503_bib51","series-title":"Bloodstream infection due to Candida (and species formerly part of the Candida genus) in England: 2022","year":"2023"},{"issue":"9","key":"10.1016\/j.jinf.2025.106503_bib52","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.3390\/microorganisms9091868","article-title":"Migration of Escherichia coli and Klebsiella pneumoniae Carbapenemase (KPC)-producing Enterobacter cloacae through wastewater pipework and establishment in hospital sink waste traps in a laboratory model system","volume":"9","author":"Aranega-Bou","year":"2021","journal-title":"Microorganisms"},{"issue":"1","key":"10.1016\/j.jinf.2025.106503_bib53","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jhin.2012.06.007","article-title":"Multidrug-resistant Pseudomonas aeruginosa outbreaks in two hospitals: association with contaminated hospital waste-water systems","volume":"82","author":"Breathnach","year":"2012","journal-title":"J Hosp Infect"},{"issue":"10","key":"10.1016\/j.jinf.2025.106503_bib54","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0025962","article-title":"Low prevalence of rotavirus and high prevalence of norovirus in hospital and community wastewater after introduction of rotavirus vaccine in Nicaragua","volume":"6","author":"Bucardo","year":"2011","journal-title":"PloS One"},{"key":"10.1016\/j.jinf.2025.106503_bib55","doi-asserted-by":"crossref","DOI":"10.1016\/j.watres.2021.117882","article-title":"Higher abundance of core antimicrobial resistant genes in effluent from wastewater treatment plants","volume":"208","author":"Raza","year":"2022","journal-title":"Water Res"},{"key":"10.1016\/j.jinf.2025.106503_bib56","doi-asserted-by":"crossref","DOI":"10.1016\/j.watres.2024.121208","article-title":"Characterization of heavy metal, antibiotic pollution, and their resistance genes in paddy with secondary municipal-treated wastewater irrigation","volume":"252","author":"Yan","year":"2024","journal-title":"Water Res"},{"issue":"6","key":"10.1016\/j.jinf.2025.106503_bib57","article-title":"Bacterial hosts of clinically significant beta-lactamase genes in Croatian wastewaters","volume":"100","author":"Deki\u0107 Rozman","year":"2024","journal-title":"FEMS Microbiol Ecol"},{"issue":"2024","key":"10.1016\/j.jinf.2025.106503_bib58","article-title":"Metagenomic profiling of raw wastewater in Portugal highlights microbiota and resistome signatures of public health interest beyond the usual suspects","volume":"946","author":"Ramos","year":"2024","journal-title":"Sci Total Environ"},{"issue":"12","key":"10.1016\/j.jinf.2025.106503_bib59","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1038\/nrmicro1789","article-title":"An increasing threat in hospitals: multidrug-resistant Acinetobacter baumannii","volume":"5","author":"Dijkshoorn","year":"2007","journal-title":"Nat Rev Microbiol"},{"key":"10.1016\/j.jinf.2025.106503_bib60","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2024.1412775","article-title":"Acinetobacter pittii: the emergence of a hospital-acquired pathogen analyzed from the genomic perspective","volume":"15","author":"Bello-L\u00f3pez","year":"2024","journal-title":"Front Microbiol"},{"key":"10.1016\/j.jinf.2025.106503_bib61","article-title":"Genomic sequencing surveillance of patients colonized with vancomycin-resistant Enterococcus (VRE) improves detection of hospital-associated transmission","author":"Sundermann","year":"2024","journal-title":"medRxiv"},{"key":"10.1016\/j.jinf.2025.106503_bib62","series-title":"A Report from Public Health Wales Antimicrobial Resistance Programme Surveillance Unit: Antibacterial Usage in Secondary Care in Wales 2005\u20132014","year":"2015"},{"issue":"6","key":"10.1016\/j.jinf.2025.106503_bib63","doi-asserted-by":"crossref","first-page":"e370","DOI":"10.1016\/S2214-109X(16)30064-X","article-title":"Seasonal dynamics of bacterial meningitis: a time-series analysis","volume":"4","author":"Paireau","year":"2016","journal-title":"Lancet Glob Health"},{"issue":"1","key":"10.1016\/j.jinf.2025.106503_bib64","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1128\/AEM.71.1.85-92.2005","article-title":"Temperature-driven Campylobacter seasonality in England and Wales","volume":"71","author":"Louis","year":"2005","journal-title":"Appl Environ Microbiol"},{"issue":"1","key":"10.1016\/j.jinf.2025.106503_bib65","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1017\/S095026881700259X","article-title":"Seasonality of urinary tract infections in the United Kingdom in different age groups: longitudinal analysis of the Health Improvement Network (THIN)","volume":"146","author":"Rosello","year":"2018","journal-title":"Epidemiol Infect"},{"issue":"9","key":"10.1016\/j.jinf.2025.106503_bib66","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.1093\/jac\/dkab204","article-title":"Incidence of Clostridioides difficile infection (CDI) related to antibiotic prescribing by GP surgeries in Wales","volume":"76","author":"Tydeman","year":"2021","journal-title":"J Antimicrob Chemother"},{"key":"10.1016\/j.jinf.2025.106503_bib67","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.envpol.2017.01.054","article-title":"Abundance of antibiotics, antibiotic resistance genes and bacterial community composition in wastewater effluents from different Romanian hospitals","volume":"225","author":"Szekeres","year":"2017","journal-title":"Environ Pollut"},{"key":"10.1016\/j.jinf.2025.106503_bib68","doi-asserted-by":"crossref","DOI":"10.1016\/j.watres.2024.121665","article-title":"Antimicrobials and antimicrobial resistance genes in the shadow of COVID-19 pandemic: A wastewater-based epidemiology perspective","volume":"257","author":"Xu","year":"2024","journal-title":"Water Res"},{"key":"10.1016\/j.jinf.2025.106503_bib69","doi-asserted-by":"crossref","DOI":"10.1016\/j.envint.2022.107488","article-title":"Predicting selection for antimicrobial resistance in UK wastewater and aquatic environments: Ciprofloxacin poses a significant risk","volume":"169","author":"Hayes","year":"2022","journal-title":"Environ Int"},{"issue":"1","key":"10.1016\/j.jinf.2025.106503_bib70","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1186\/s12879-022-07410-6","article-title":"Impact of antimicrobial stewardship programs on antibiotic consumption and antimicrobial resistance in four Colombian healthcare institutions","volume":"22","author":"Pallares","year":"2022","journal-title":"BMC Infect Dis"},{"issue":"5","key":"10.1016\/j.jinf.2025.106503_bib71","doi-asserted-by":"crossref","first-page":"601","DOI":"10.3390\/antibiotics11050601","article-title":"Antimicrobial resistance patterns and clonal distribution of E. coli, Enterobacter spp. and Acinetobacter spp. Strains isolated from two hospital wastewater plants","volume":"11","author":"Galarde-L\u00f3pez","year":"2022","journal-title":"Antibiotics"},{"key":"10.1016\/j.jinf.2025.106503_bib72","doi-asserted-by":"crossref","DOI":"10.1016\/j.scitotenv.2021.151339","article-title":"Dissemination of carbapenem resistant bacteria from hospital wastewater into the environment","volume":"806","author":"Kehl","year":"2022","journal-title":"Sci Total Environ"},{"issue":"4","key":"10.1016\/j.jinf.2025.106503_bib73","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1038\/nrmicro2312","article-title":"Call of the wild: antibiotic resistance genes in natural environments","volume":"8","author":"Allen","year":"2010","journal-title":"Nat Rev Microbiol"},{"issue":"1","key":"10.1016\/j.jinf.2025.106503_bib74","doi-asserted-by":"crossref","DOI":"10.1016\/j.imj.2024.100092","article-title":"Efficacy of new generation biosorbents for the sustainable treatment of antibiotic residues and antibiotic resistance genes from polluted waste effluent","volume":"3","author":"Madhogaria","year":"2024","journal-title":"Infect Med"},{"key":"10.1016\/j.jinf.2025.106503_bib75","series-title":"Safe management of wastes from health-care activities","author":"Chartier","year":"2014"},{"key":"10.1016\/j.jinf.2025.106503_bib76","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.jenvman.2015.11.021","article-title":"Hospital effluents management: chemical, physical, microbiological risks and legislation in different countries","volume":"168","author":"Carraro","year":"2016","journal-title":"J Environ Manag"},{"issue":"2","key":"10.1016\/j.jinf.2025.106503_bib77","doi-asserted-by":"crossref","first-page":"210","DOI":"10.3390\/antibiotics11020210","article-title":"Inactivation of antibiotic-resistant bacteria in wastewater by ozone-based advanced water treatment processes","volume":"11","author":"Azuma","year":"2022","journal-title":"Antibiotics"},{"issue":"37","key":"10.1016\/j.jinf.2025.106503_bib78","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11356-024-34475-4","article-title":"Non-thermal obliteration of critically ranked carbapenem-resistant Acinetobacter baumannii and its resistance gene in a batch atmospheric plasma reactor","volume":"31","author":"Mosaka","year":"2024","journal-title":"Environ Sci Pollut Res"},{"key":"10.1016\/j.jinf.2025.106503_bib79","series-title":"Pharmaceuticals in the environment: Sources, fate, effects and risks","first-page":"3","article-title":"Pharmaceuticals in the environment\u2013a brief summary","author":"K\u00fcmmerer","year":"2008"}],"container-title":["Journal of Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0163445325000970?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0163445325000970?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T04:15:48Z","timestamp":1778300148000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0163445325000970"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":79,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["S0163445325000970"],"URL":"https:\/\/doi.org\/10.1016\/j.jinf.2025.106503","relation":{},"ISSN":["0163-4453"],"issn-type":[{"value":"0163-4453","type":"print"}],"subject":[],"published":{"date-parts":[[2025,6]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Metagenomic profiling of hospital wastewater: A comprehensive national scale analysis of antimicrobial resistance genes and opportunistic pathogens","name":"articletitle","label":"Article Title"},{"value":"Journal of Infection","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jinf.2025.106503","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Author(s). Published by Elsevier Ltd on behalf of The British Infection Association.","name":"copyright","label":"Copyright"}],"article-number":"106503"}}