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In this study, an ozone treatment facility was established for an advanced hospital wastewater treatment in a core hospital facility in an urban area in Japan to evaluate the inactivation of antimicrobial-resistant bacteria and antimicrobials. Metagenomic DNA-seq analysis and the isolation of potential extended-spectrum \u03b2-lactamase (ESBL)-producing bacteria suggested that ozone exposure for at least 20 min is required for the adequate inactivation of DNA and ESBL-producing bacteria. Escherichia coli and Klebsiella species were markedly susceptible to 20-min ozone exposure, whereas Raoultella ornithinolytica and Pseudomonas putida were isolated even after an 80-min exposure. These ozone-resistant bacteria might play a pivotal role as AMR reservoirs in the environment. Nine antimicrobials (ampicillin, cefdinir, cefpodoxime, ciprofloxacin, levofloxacin, clarithromycin, chlortetracycline, minocycline, and vancomycin) were detected at 373 ng\/L to 27 \u03bcg\/L in the hospital wastewater, and these were removed (96\u2013100% removal) after a 40-min treatment. These results facilitate a comprehensive understanding of the AMR risk posed by hospital wastewater and provides insights for devising strategies to eliminate or mitigate the burden of antimicrobial-resistant bacteria and the flow of antimicrobials into the environment. To the best of our knowledge, this is the first report on the implementation of a batch-type, plant-scale ozone treatment system in a hospital facility to execute and evaluate the inactivation of drug-resistant bacteria and antimicrobials.<\/jats:p>","DOI":"10.3390\/antibiotics11070862","type":"journal-article","created":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T22:31:14Z","timestamp":1656369074000},"page":"862","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Inactivation of Bacteria and Residual Antimicrobials in Hospital Wastewater by Ozone Treatment"],"prefix":"10.3390","volume":"11","author":[{"given":"Takashi","family":"Azuma","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Sciences, Osaka Medical and Pharmaceutical University, Takatsuki 569-1094, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5894-4563","authenticated-orcid":false,"given":"Miwa","family":"Katagiri","sequence":"additional","affiliation":[{"name":"Department of Surgery, Toho University Ohashi Medical Center, Tokyo 153-8515, Meguro-ku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Sekizuka","sequence":"additional","affiliation":[{"name":"Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo 162-8640, Shinjyuku-ku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0487-4405","authenticated-orcid":false,"given":"Makoto","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo 162-8640, Shinjyuku-ku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8916-4663","authenticated-orcid":false,"given":"Manabu","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Surgery, Toho University Ohashi Medical Center, Tokyo 153-8515, Meguro-ku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s13756-015-0091-2","article-title":"Antimicrobial resistance: One world, one fight!","volume":"4","author":"Harbarth","year":"2015","journal-title":"Antimicrob. 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