{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T10:22:14Z","timestamp":1787998934479,"version":"build-2784847793"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Open Access Publication Fund of the University of Bonn"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Antimicrobial resistance (AMR) in hospital wastewater is a recognized public health concern, yet the dynamics of its emergence remain poorly understood. This study aimed to characterize the quantitative and qualitative changes in the microbial community of a newly built internal medicine intensive care hospital wing following the start of patient treatment. Wastewater samples were collected regularly from eight relevant sites, including seven patient-associated locations within the intensive care ward and the central sanitary sewer where all effluent converged. Culture-based analyses targeted the \u201cESCAPE-SO\u201d bacterial and fungal groups (\u201cEnterococci\u201d, \u201cStaphylococci\u201d, \u201cCandida\u201d, \u201cAcinetobacter\u201d, \u201cPseudomonas\u201d, \u201cEnterobacteriaceae\u201d, \u201cStenotrophomonas\u201d, \u201cOthers\u201d). Comparisons were made between a 12-month pre-operation period (only flushing every 72 h to prevent contamination of the drinking water system) and the first 12 months of patient treatment. The results showed a significant increase in mean bacterial concentrations from 53 [0\u2013349] CFU\/mL before patient treatment to 8423 [3054\u201379,490] CFU\/mL during patient treatment (p = 0.0224) with a particular focus on Pseudomonas spp. as the dominant genus. Resistance against all four main antibiotic classes of the WHO AWaRe essential \u201cwatch\u201d list (carbapenems, third-generation cephalosporins, broad-spectrum penicillin and ciprofloxacin) emerged within the first twelve months and depended on the amount of prescribed antibiotics and the number of patients treated. These findings indicate that hospital activity drives rapid development of antimicrobial resistance in wastewater microbial communities, highlighting the critical role of clinical antibiotic use in shaping environmental resistomes. This study provides quantitative evidence that resistance can emerge within months of hospital operation, emphasizing the need for early monitoring and targeted interventions to mitigate the spread of AMR from hospital effluents into broader environmental systems.<\/jats:p>","DOI":"10.3390\/microorganisms14020285","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T10:24:36Z","timestamp":1769423076000},"page":"285","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hospital Wing Opening Sparks Antimicrobial Resistance in Wastewater Microbial Community Within the First Twelve Months"],"prefix":"10.3390","volume":"14","author":[{"given":"Laura","family":"Lohbrunner","sequence":"first","affiliation":[{"name":"Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, 53127 Bonn, Germany"},{"name":"Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Baessler","sequence":"additional","affiliation":[{"name":"Department of Hospital Pharmacy, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"D\u00f6hla","sequence":"additional","affiliation":[{"name":"Department of Hospital Pharmacy, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Droll","sequence":"additional","affiliation":[{"name":"Hospital Management, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4875-1519","authenticated-orcid":false,"given":"Ralf M.","family":"Hagen","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany"},{"name":"Institute of Medical Microbiology, Immunology and Parasitology, Medical Faculty, University of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0156-9595","authenticated-orcid":false,"given":"Nico T.","family":"Mutters","sequence":"additional","affiliation":[{"name":"Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Reyhe","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Weppler","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8029-5264","authenticated-orcid":false,"given":"Manuel","family":"D\u00f6hla","sequence":"additional","affiliation":[{"name":"Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, 53127 Bonn, Germany"},{"name":"Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref_1","unstructured":"United Nations General Assembly (2025, September 24). Political Declaration of the High-Level Meeting of the General Assembly on Antimicrobial Resistance: A\/RES\/71\/3. Available online: https:\/\/digitallibrary.un.org\/record\/845917\/files\/A_RES_71_3-EN.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e70022","DOI":"10.1002\/puh2.70022","article-title":"Top 10 Public Health Challenges for 2024: Charting a New Direction for Global Health Security","volume":"4","author":"Shomuyiwa","year":"2025","journal-title":"Public Health Chall."},{"key":"ref_3","unstructured":"United Nations General Assembly (2025, September 24). Political Declaration of the High-Level Meeting on Antimicrobial Resistance. Available online: https:\/\/www.un.org\/pga\/wp-content\/uploads\/sites\/108\/2024\/09\/FINAL-Text-AMR-to-PGA.pdf."},{"key":"ref_4","unstructured":"World Health Organization (2025, September 24). Global Research Agenda for Antimicrobial Resistance in Human Health: Policy Brief, Geneva. Available online: https:\/\/cdn.who.int\/media\/docs\/default-source\/antimicrobial-resistance\/amr-spc-npm\/who-global-research-agenda-for-amr-in-human-health---policy-brief.pdf?sfvrsn=f86aa073_4&download=true."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.ijheh.2019.03.006","article-title":"Antibiotic resistant bacteria and resistance genes in biofilms in clinical wastewater networks","volume":"222","author":"Sib","year":"2019","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"142265","DOI":"10.1016\/j.scitotenv.2020.142265","article-title":"Clinically relevant antibiotic-resistant bacteria in aquatic environments\u2014An optimized culture-based approach","volume":"750","author":"Schreiber","year":"2021","journal-title":"Sci. Total Environ."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"125032","DOI":"10.1016\/j.chemosphere.2019.125032","article-title":"Association between antibiotic residues, antibiotic resistant bacteria and antibiotic resistance genes in anthropogenic wastewater\u2014An evaluation of clinical influences","volume":"241","author":"Voigt","year":"2020","journal-title":"Chemosphere"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s13756-025-01600-y","article-title":"Multicenter exploration of microbial communities in hospital toilets reveals: Antibiotic exposure in a nosocomial settings selects for coEnterococcus over commensal taxa","volume":"14","author":"Neuenhoff","year":"2025","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s13756-023-01236-w","article-title":"Hospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens, even over many years","volume":"12","author":"Sib","year":"2023","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"140894","DOI":"10.1016\/j.scitotenv.2020.140894","article-title":"Bacteria isolated from hospital, municipal and slaughterhouse wastewaters show characteristic, different resistance profiles","volume":"746","author":"Sib","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1007\/s11356-018-3563-0","article-title":"Antibiotics in hospital effluents: Occurrence, contribution to urban wastewater, removal in a wastewater treatment plant, and environmental risk assessment","volume":"26","author":"Aydin","year":"2019","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_12","unstructured":"European Center of Disease Control (2025, October 28). Antimicrobial Consumption in the EU\/EEA (ESAC-Net): Annual Epidemiological Report for 2023, Stockholm. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/ESAC-Net_report-2023.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"290","DOI":"10.2471\/BLT.22.288614","article-title":"The WHO AWaRe (Access, Watch, Reserve) antibiotic book and prevention of antimicrobial resistance","volume":"101","author":"Zanichelli","year":"2023","journal-title":"Bull. World Health Organ."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"45","DOI":"10.18773\/austprescr.2020.008","article-title":"Oral or intravenous antibiotics?","volume":"43","author":"McCarthy","year":"2020","journal-title":"Aust. Prescr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1089\/sur.2021.040","article-title":"Effect of an Intensified Antibiotic Stewardship Program at an Orthopedic Surgery Department","volume":"23","author":"Feihl","year":"2022","journal-title":"Surg. Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"102753","DOI":"10.1016\/j.jiac.2025.102753","article-title":"Global impact of antimicrobial stewardship programs in Healthcare: An umbrella review of effectiveness, cost-efficiency, and implementation strategies","volume":"31","author":"Krishnamoorthy","year":"2025","journal-title":"J. Infect. Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e2253806","DOI":"10.1001\/jamanetworkopen.2022.53806","article-title":"Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally: A Systematic Review and Meta-Analysis","volume":"6","author":"Win","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_18","unstructured":"Koesling, D., and Bozzaro, C. (2022). The post-antibiotic era: An existential threat for humanity. Intergener. Justice Rev., 8."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"26717","DOI":"10.1038\/srep26717","article-title":"Phage selection restores antibiotic sensitivity in MDR Pseudomonas aeruginosa","volume":"6","author":"Chan","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Nolasco-Rojas, A.E., Cruz-Del-Agua, E., Cruz-Cruz, C., Loyola-Cruz, M.\u00c1., Ayil-Guti\u00e9rrez, B.A., Tamayo-Ord\u00f3\u00f1ez, M.C., Tamayo-Ordo\u00f1ez, Y.d.J., Rojas-Bernab\u00e9, A., Tamayo-Ordo\u00f1ez, F.A., and Dur\u00e1n-Manuel, E.M. (2025). Microbiological Risks to Health Associated with the Release of Antibiotic-Resistant Bacteria and \u03b2-Lactam Antibiotics Through Hospital Wastewater. Pathogens, 14.","DOI":"10.3390\/pathogens14050402"},{"key":"ref_21","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."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"171","DOI":"10.2166\/washdev.2020.086","article-title":"Hospital wastewater effluent: Hot spot for antibiotic resistant bacteria","volume":"10","author":"Rozman","year":"2020","journal-title":"J. Water Sanit. Hyg. Dev."},{"key":"ref_23","unstructured":"(2025, September 28). Verordnung \u00dcber Die Qualit\u00e4t von Wasser f\u00fcr den Menschlichen Gebrauch (Trinkwasserverordnung\u2014TrinkwV): Trinkwasserverordnung (TrinkwV). Available online: https:\/\/www.gesetze-im-internet.de\/trinkwv_2023\/BJNR09F0B0023.html."},{"key":"ref_24","unstructured":"Verein Deutscher Ingenieure, and DVGW Deutscher Verein des Gas- und Wasserfaches e. V (2023). VDI\/DVGW 6023: Hygiene in Trinkwasser-Installationen\u2014Anforderungen an Planung, Ausf\u00fchrung, Betrieb und Instandhaltung, VDI e.V.. Available online: https:\/\/www.vdi.de\/mitgliedschaft\/vdi-richtlinien\/details\/vdi-6023-blatt-1-hygiene-in-trinkwasser-installationen-anforderungen-an-planung-ausfuehrung-betrieb-und-instandhaltung."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Kamm, L., Hagen, R.M., Mutters, N.T., Schmithausen, R.M., Weppler, R., and D\u00f6hla, M. (2025). Drinking Water and Sanitation Safety Planning for Medical Facilities: An Innovative PoU Approach for a Water System Description Using Ecomaps. Environments, 12.","DOI":"10.3390\/environments12070217"},{"key":"ref_26","unstructured":"European Committee on Antimicrobial Susceptibility Testing (2025, September 28). EUCAST Disk Diffusion Method: Manual v 13.0. Available online: https:\/\/www.eucast.org\/fileadmin\/eucast\/pdf\/disk_test_documents\/2025\/Manual_v_13.0_EUCAST_Disk_Test_2025.pdf."},{"key":"ref_27","unstructured":"EUCAST (2025, September 28). Breakpoint Tables for Interpretation of MICs and Zone Diameters. Available online: https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Breakpoint_tables\/v_15.0_Breakpoint_Tables.pdf."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kelly, J.B., Nolan, A.C., and Zeden, M.S. (2024). How can we escape the ESKAPEs: Antimicrobial resistance mechanisms and what lies ahead?. PLoS Pathog., 20.","DOI":"10.1371\/journal.ppat.1012270"},{"key":"ref_29","unstructured":"Deutscher Wetterdienst (2026, January 04). Precipitation (Niederschlag). Available online: https:\/\/www.dwd.de\/EN\/ourservices\/germanclimateatlas\/explanations\/elements\/_functions\/faqkarussel\/niederschlag.html."},{"key":"ref_30","unstructured":"EUCAST (2025, September 28). Breakpoint Tables for Interpretation of MICs and Zone Diameters. Available online: https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Breakpoint_tables\/v_13.1_Breakpoint_Tables.pdf."},{"key":"ref_31","unstructured":"EUCAST (2025, September 28). Breakpoint Tables for Interpretation of MICs and Zone Diameters. Available online: https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Breakpoint_tables\/v_14.0_Breakpoint_Tables.pdf."},{"key":"ref_32","unstructured":"World Health Organization (2003). Introduction to Drug Utilization Research, World Health Organization."},{"key":"ref_33","unstructured":"Norwegian Institute of Public Health (2025, December 01). ATC\/DDD Index 2025. Available online: https:\/\/atcddd.fhi.no\/atc_ddd_index\/."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Leistner, B., Rauschning, D., Hagen, R.M., Sre\u010dec, F., Mutters, N.T., Weppler, R., Mutschnik, C., and D\u00f6hla, M. (2025). Logistic Stewardship: Supporting Antimicrobial Stewardship Programs Based on Antibiotics Goods Flow. Antibiotics, 14.","DOI":"10.3390\/antibiotics14010043"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1128\/AAC.43.2.424","article-title":"Carbapenem activities against Pseudomonas aeruginosa: Respective contributions of OprD and efflux systems","volume":"43","author":"Epp","year":"1999","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1093\/jac\/47.3.247","article-title":"Of Pseudomonas, porins, pumps and carbapenems","volume":"47","author":"Livermore","year":"2001","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Jordana-Lluch, E., Barcel\u00f3, I.M., Escobar-Salom, M., Est\u00e9vez, M.A., Zamorano, L., G\u00f3mez-Zorrilla, S., Sendra, E., Oliver, A., and Juan, C. (2023). The balance between antibiotic resistance and fitness\/virulence in Pseudomonas aeruginosa: An update on basic knowledge and fundamental research. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1270999"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"dlae140","DOI":"10.1093\/jacamr\/dlae140","article-title":"Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of blaKPC-carbapenemase-producing Enterobacterales in a hospital setting","volume":"6","author":"Stoesser","year":"2024","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_39","unstructured":"Exner, M., Schwartz, T., and Schmithausen, R. (2022). HyReKa Synthese- und Abschlussbericht Antibiotikaresistenter Krankheitserreger aus Klinischen, Landwirtschaftlichen und Kommunalen Abw\u00e4ssern 2022, University Hospital Bonn. Available online: https:\/\/www.ukbonn.de\/site\/assets\/files\/29796\/hyreka_abschlussbericht_formatiert.pdf."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Zacharias, N., L\u00f6ckener, I., Essert, S.M., Sib, E., Bierbaum, G., Kistemann, T., and Schreiber, C. (2021). Antibiotic-Resistant Bacteria in Clams-A Study on Mussels in the River Rhine. Antibiotics, 10.","DOI":"10.3390\/antibiotics10050571"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"113449","DOI":"10.1016\/j.ijheh.2020.113449","article-title":"The investigation of antibiotic residues, antibiotic resistance genes and antibiotic-resistant organisms in a drinking water reservoir system in Germany","volume":"224","author":"Voigt","year":"2020","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s12403-019-00313-z","article-title":"Assessment of the Prevalence of Antibiotic-Resistant Bacteria and the Concentration of Antibiotics in EU Bathing Waters in Western Germany","volume":"12","author":"Sib","year":"2020","journal-title":"Expo Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"8952","DOI":"10.1038\/s41598-020-65635-4","article-title":"Evaluation of antibiotic resistance dissemination by wastewater treatment plant effluents with different catchment areas in Germany","volume":"10","author":"Alexander","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"J\u00e4ger, T., Hembach, N., Elpers, C., Wieland, A., Alexander, J., Hiller, C., Krauter, G., and Schwartz, T. (2018). Reduction of Antibiotic Resistant Bacteria During Conventional and Advanced Wastewater Treatment, and the Disseminated Loads Released to the Environment. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.02599"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Hembach, N., Schmid, F., Alexander, J., Hiller, C., Rogall, E.T., and Schwartz, T. (2017). Occurrence of the mcr-1 Colistin Resistance Gene and other Clinically Relevant Antibiotic Resistance Genes in Microbial Populations at Different Municipal Wastewater Treatment Plants in Germany. Front. Microbiol., 8.","DOI":"10.3389\/fmicb.2017.01282"},{"key":"ref_46","unstructured":"Landesamt f\u00fcr Natur, Umwelt und Verbraucherschutz NRW (2010). Nachweis von Antibiotikaresistenzgenen in Kl\u00e4ranlagen mittels Microarray, Landesamt f\u00fcr Natur, Umwelt und Verbraucherschutz NRW."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/2\/285\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T10:42:40Z","timestamp":1769424160000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/2\/285"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["microorganisms14020285"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14020285","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]}}}