Abstract
Antimicrobial resistance (AMR) poses a critical global health threat. Wastewater surveillance has recently emerged as a valuable public health tool for monitoring AMR in communities and healthcare settings. This narrative review comprehensively examines the role of hospital wastewater surveillance (HWWS) in monitoring antimicrobial resistance. Methods to detect resistant bacteria and antimicrobial resistance genes (ARGs) in wastewater systems, ranging from culture-based techniques to advanced molecular approaches, including polymerase chain reaction (PCR) and next-generation sequencing (NGS), are explored. The review synthesizes data on key antimicrobial resistance genes commonly detected in hospital effluents and explores how HWWS contributes to understanding the dynamics of resistance within healthcare settings. Furthermore, it identifies methodological challenges and inconsistencies in data reporting and outlines necessary standardization steps to enhance the effectiveness of HWWS programs. Opportunities for integrating HWWS with clinical and public health frameworks are presented, emphasizing the need for robust metadata and transparent reporting. This review provides a comprehensive approach to HWWS strategies, which could complement robust infection control and antibiotic stewardship interventions to combat AMR.