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. 2026 Jan 3;15(1):50.
doi: 10.3390/antibiotics15010050.

First Multi-Facility Antimicrobial Surveillance in Japanese Hospital Wastewater Reveals Spatiotemporal Trends and Source-Specific Environmental Loads

Takashi Azuma  1   2 , Ai Tsukada  3 , Naoki Fujii  3 , Miwa Katagiri  4 , Itaru Nakamura  5   6 , Hidefumi Shimizu  7 , Keita Tatsuno  8 , Manabu Watanabe  4 , Norio Ohmagari  3   9 , Nobuaki Matsunaga  3   9
Affiliations

First Multi-Facility Antimicrobial Surveillance in Japanese Hospital Wastewater Reveals Spatiotemporal Trends and Source-Specific Environmental Loads

Takashi Azuma et al. Antibiotics (Basel). .

Abstract

Background: Hospitals are recognized as point sources of antimicrobials in urban wastewater systems; however, comprehensive evaluations of their discharge profiles have not yet been conducted. Methods: This study presents a multi-site investigation of residual antimicrobial concentrations in effluents from five general hospitals and a commercial facility in the metropolitan area of Japan. Over a 12-week period (December 2023-March 2024), extensive sampling was conducted. Fifteen antimicrobials from multiple classes were quantified using high-throughput analysis. Results: The results revealed consistently higher concentrations in hospital effluents, particularly for levofloxacin, vancomycin, and ampicillin, than in non-clinical sites. Distinct facility-specific and temporal patterns suggest strong links between local prescribing practices and the effluent composition. Some compounds, such as clarithromycin and minocycline, showed dual contributions from both hospital and commercial sources. Conclusions: These findings highlight the need for source-targeted monitoring and antimicrobial pollution control strategies and provide a foundation for expanding surveillance efforts and informing environmental policies related to antimicrobial resistance (AMR).

Keywords: antimicrobial resistance (AMR); antimicrobials; health care and the environment; high-throughput analysis; hospital wastewater; wastewater monitoring survey.

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Conflict of interest statement

The funding agencies had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Distribution of concentrations of antimicrobials in five different hospital wastewater (Hospital A–E) effluent and wastewater from commercial facility investigated in the urban regions of Japan. Different characters within the violin plot indicate significant differences between groups (p < 0.05).
Figure 1
Figure 1
Distribution of concentrations of antimicrobials in five different hospital wastewater (Hospital A–E) effluent and wastewater from commercial facility investigated in the urban regions of Japan. Different characters within the violin plot indicate significant differences between groups (p < 0.05).
Figure 2
Figure 2
Temporal trends in detected concentrations (ng/L) of seven representative antimicrobials (ampicillin, cefpodoxime, levofloxacin, azithromycin, clarithromycin, minocycline, and vancomycin) in wastewater from five hospitals (Hospitals A–E) over a monitoring period.
Figure 3
Figure 3
Temporal variation in the concentration ratio (hospital wastewater/commercial facility wastewater) for three representative antimicrobials (clarithromycin, levofloxacin, and vancomycin) over the sampling period from December 2023 to March 2024. The horizontal axis shows the passage of time during the drainage sampling period.
Figure 4
Figure 4
Density distribution of the concentrations (log10 ng/L) of clarithromycin, levofloxacin, and vancomycin in hospital and commercial facility wastewaters. The horizontal axis shows the log10 value of the detected antimicrobial concentration.
See this image and copyright information in PMC

References

    1. Albarano L., Padilla Suarez E.G., Maggio C., La Marca A., Iovine R., Lofrano G., Guida M., Vaiano V., Carotenuto M., Libralato G. Assessment of ecological risks posed by veterinary antibiotics in european aquatic environments: A comprehensive review and analysis. Sci. Total Environ. 2024;954:176280. doi: 10.1016/j.scitotenv.2024.176280. - DOI - PubMed
    1. Bouabadi I., Miyah Y., Benjelloun M., El-habacha M., El Addouli J. Advanced strategies for the innovative treatment of hospital liquid effluents: A comprehensive review. Bioresour. Technol. Rep. 2024;28:101990. doi: 10.1016/j.biteb.2024.101990. - DOI
    1. Zhang S., Li J., Lai J., Zhang Q., Zhao Z., Li B. Transfer dynamics of intracellular and extracellular last-resort antibiotic resistome in hospital wastewater. Water Res. 2025;283:123833. doi: 10.1016/j.watres.2025.123833. - DOI - PubMed
    1. Mejías C., Martín-Pozo L., Santos J.L., Martín J., Aparicio I., Alonso E. Occurrence, dissipation kinetics and environmental risk assessment of antibiotics and their metabolites in agricultural soils. J. Hazard. Mater. 2024;479:135586. doi: 10.1016/j.jhazmat.2024.135586. - DOI - PubMed
    1. Chen M., Wang G., Ma B., Musat N., Shen P., Wei Z., Wei Y., Richnow H.H., Zhang J. Deciphering the transfer of antimicrobial resistance genes in the urban water cycle from water source to reuse: A review. Environ. Int. 2025;201:109584. doi: 10.1016/j.envint.2025.109584. - DOI - PubMed

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