Dinamika Resistensi Antimikroba dan Dampak Ekotoksikologi Limbah Cair Rumah Sakit terhadap Ekosistem
DOI:
https://doi.org/10.63822/rn974z97Keywords:
Antimicrobial resistance, hospital wastewater, environmental toxicologyAbstract
Antimicrobial resistance and environmental pollution from hospital wastewater are global problems that threaten human health and ecosystems. Wastewater from healthcare facilities contains pathogenic microorganisms, antibiotic residues, resistance genes, as well as chemical pollutants that cannot be completely removed by conventional waste treatment systems. The research method was conducted based on a literature review, including experimental approaches, field surveys, and literature studies. The results of the study indicate that the presence of biofilms in drainage channels serves as a major reservoir for multi-drug resistant (MDR) bacteria and facilitates horizontal transfer of resistance genes, accelerating the emergence of increasingly resistant microbial strains. Non-antibiotic pollutants such as analgesic drugs and caffeine also affect the composition of the wastewater microbiome and increase the risk of pathogen growth and resistance. The toxicological impacts of this pollution can cause oxidative stress and tissue damage in aquatic organisms, as well as serious problems in the food chain cycle. Conventional waste treatment often cannot filter all residues and resistance genes, thus requiring the application of more advanced treatment technologies such as advanced oxidation and the use of nanomaterials. To reduce this risk, hospital waste management must be conducted systematically and scientifically, including controlling the rational use of antibiotics and improving the effectiveness of wastewater treatment systems. This approach is important to protect public health, maintain the sustainability of aquatic ecosystems, and prevent the widespread spread of antibiotic resistance.
References
Ahmed, S. K., Hussein, S., Qurbani, K., Ibrahim, R. H., Fareeq, A., Mahmood, K. A., & Mohamed, M. G. (2024). Antimicrobial resistance: Impacts, challenges, and future prospects. Journal of Medicine, Surgery, and Public Health, 2, 100081. https://doi.org/10.1016/j.glmedi.2024.100081
Aleem, M., Azeem, A. R., Rahmatullah, S., Vohra, S., Nasir, S., & Andleeb, S. (2021). Prevalence of bacteria and antimicrobial resistance genes in hospital water and surfaces. Cureus, 13(10), e18738. https://doi.org/10.7759/cureus.18738
Aminudin, M. H., Amalina, F., Ab Hamid, M. R., Sulaiman, S., Afza, N., & Razak, A. S. A. (2026). Environmental and public health risks of antibiotic resistance gene pollution in poultry systems: Sustainability impact, transmission pathways, and mitigation strategies. The Microbe, 10, 100658. https://doi.org/10.1016/j.microb.2026.100658
Arhafna, C. H., Fadhliana, N., Firdus., Rizki, A., & Nasir, M. (2025). Studi Toksikologi: mikroplastik pada organisme perairan dan resiko terhadap kesehatan manusia di Indonesia. Jurnal Jeumpa. https://10.33059/jj.v12i1.11379
Asfaw, T. (2018). Review on hospital wastewater as a source of emerging drug resistance pathogens. Journal of Research in Environmental Science and Toxicology, 7(2), 47–52. http://dx.doi.org/10.14303/jrest.2018.020.
Bakon, S. K., Mohamad, Z. A., Jamilan, M. A., Hashim, H., Kuman, M. Y., Shaharudin, R., Ahmad, N., & Muhamad, N. A. (2023). Prevalence of Antibiotic-Resistant Pathogenic Bacteria and Level of Antibiotic Residues in Hospital Effluents in Selangor, Malaysia: Protocol for a Cross-sectional Study. JMIR Research Protocols, 29(12), 1–12. https://doi.org/10.2196/39022
Brown, K. D., Kulis, J., Thomson, B., Chapman, T. H., & Mawhinney, D. B. (2006). Occurrence of antibiotics in hospital, residential, and dairy effluent, municipal wastewater, and the Rio Grande in New Mexico. Science of the Total Environment, 366(2-3), 772-783. https://doi.org/10.1016/j.scitotenv.2005.10.007
Chen, M., Liu, Y., Zhou, Y., Pei, Y., Qu, M., Lv, P., Zhang, J., Xu, X., Hu, Y., & Wang, Y. (2025). Deciphering antibiotic resistance genes and plasmids in pathogenic bacteria from 166 hospital effluents in Shanghai, China. Journal of Hazardous Materials, 483, 136562. https://doi.org/10.1016/j.jhazmat.2024.136562
Deguenon, E., Dougnon, V., Houssou, V. M. C., Gbotche, E., Ahoyo, R. A., Fabiyi, K., Agbankpe, J., Mousse, W., Lougbegnon, C., Klotoe, J. R., Tchobo, F., Bankole, H., & Boko, M. (2022). Hospital effluents as sources of antibiotics residues, resistant bacteria and heavy metals in Benin. SN Applied Sciences, 4, 206. https://doi.org/10.1007/s42452-022-05095-9
Fahmi, A. G., Abidin, Z., Kusmana, C., & Noor, E. (2024). Antibiotic consumption and antibiotics occurrence into the environment: A case study of hospital in Metro, Lampung. Current Research on Biosciences and Biotechnology, 5(2), 22-28. https://doi.org/10.5614/crbb.2024.5.2/V171EKVT
Giyantolin, G., Subiakto, Y., Simorangkir, T. P. H., & Widyati, W. (2025). Hospital wastewater pharmaceutical residues and their impact on community microbial resistance: An epidemiological and pharmaceutical systematic review. Indonesian Journal of Global Health Research, 7(3), 1101-1116. https://doi.org/10.37287/ijghr.v7i3.7148
Juhasz, J., Ligeti, B., Gajdács, M., Makra, N., Ostorházi, E., Farkas, F. B., Stercz, B., Tóth, Á., Domokos, J., & Pongor, S. (2021). Colonization dynamics of multidrug-resistant Klebsiella pneumoniae are dictated by microbiota cluster group behavior over individual antibiotic susceptibility: A metataxonomic analysis. Antibiotics, 10(3), 268. https://doi.org/10.3390/antibiotics10030268
Kementerian Lingkungan Hidup dan Kehutanan Republik Indonesia. (2016). Peraturan Menteri Lingkungan Hidup dan Kehutanan Republik Indonesia Nomor P.68/Menlhk/Setjen/Kum.1/8/2016 tentang baku mutu air limbah domestik. https://peraturan.bpk.go.id/Details/163527/permen-lhk-no p68menlhksetjenkum182016-tahun-2016
Kim, J., & Ahn, J. (2022). Emergence and spread of antibiotic-resistant foodborne pathogens from farm to table. Food Science and Biotechnology, 31(12), 1481-1499. https://doi.org/10.1007/s10068-022-01157-1
Kristanto, P. L., & Koven, W. (2019). preliminary study of antibiotic resistant escherichia coli in hospital wastewater treatment plants in indonesia. International Journal of Technology, 10(4), 765-775. https://dx.doi.org/10.14716/ijtech.v10i4.776
Kumari, M., Pandey, S., Giri, V.P., Bhattacharya, A., Shukla, R., Mishra, A., Nautiyal, C.S., (2017). Tailoring shape and size of biogenic silver nanoparticles to enhance antimicrobial efficacy against MDR bacteria. Microb. Pathog. 105, 346–355. https://doi.org/10.1016/j.micpath.2016.11.012
Kurniawan, I., Mariadi, P. D., & Huda, A. (2019). Hubungan tingkat penggunaan antibiotik di rumah sakit dengan potensi cemaran antibiotik di perairan umum. Prosiding Seminar Nasional II Hasil Litbangyasa Industri, 2, 165–173. https://media.neliti.com/media/publications/453531-none-53765f6a.pdf
Kusuma, S. A. F., Rostinawati, T., Hendriani, R., Budiman, M. F., & dan Parwati, I. (2021). Effect of water reservoirs types on the prevalence and antibiotic resistance profiles of Pseudomonas aeruginosa isolated from bathroom water in hospitals. Journal of Advanced Pharmaceutical Technology & Research, 12(1), 52-56. 10.4103/japtr.JAPTR_103_20
Lan, L., Wang, Y., Chen, Y., Wang, T., Zhang, J., & Tan, B. (2025). A review on the prevalence and treatment of antibiotic resistance genes in hospital wastewater. Toxics, 13(4), 263. https://doi.org/10.3390/toxics13040263
Mutuku, C., Gazdag, Z., & Melegh, S. (2022). Occurrence of antibiotics and bacterial resistance genes in wastewater: Resistance mechanisms and antimicrobial resistance control approaches. World Journal of Microbiology and Biotechnology, 38, 152. https://doi.org/10.1007/s11274-022-03334-0
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Paulus, G. K., Hornstra, L. M., Alygizakis, N., Slobodnik, J., Thomaidis, N., & Medema, G. (2019). The impact of on-site hospital wastewater treatment on the downstream communal wastewater system in terms of antibiotics and antibiotic resistance genes. International Journal of Hygiene and Environmental Health, 222(4), 635-644. https://doi.org/10.1016/j.ijheh.2019.01.004
Rajaei, M., Moosavy, M. H., Gharajalar, S. N., & Khatibi, S. A. (2021). Antibiotic resistance in the pathogenic foodborne bacteria isolated from raw kebab and hamburger: Phenotypic and genotypic study. BMC Microbiology, 21, 272. https://doi.org/10.1186/s12866-021-02326-8
Salaah, S. M., Ali, E. H. A., Mostafa, A. B., Khalil, M. T., & El-Naggar, M. M. (2025). Assessing the ecotoxicological impact of hospital wastewater on Nile tilapia and the mitigating effects of NiFe2O4 nanocomposite. Scientific African, 27, e02536. https://doi.org/10.1016/j.sciaf.2025.e02536
Samal, K., Mahapatra, S., & Ali, M. H. (2022). Pharmaceutical wastewater as emerging contaminants (EC): Treatment technologies, impact on environment and human health. Energy Nexus, 6, 100076. https://doi.org/10.1016/j.nexus.2022.100076
Sambaza, S. S., & Naicker, N. (2023). Contribution of wastewater to antimicrobial resistance: A review article. Journal of Global Antimicrobial Resistance, 34, 23-29. https://doi.org/10.1016/j.jgar.2023.05.010
Sib, E., Voigt, A. M., Wilbring, G., Schreiber, C., Faerber, H. A., Skutlarek, D., Parcina, M., Mahn, R., Wolf, D., Brossart, P., Geiser, F., Engelhart, S., Exner, M., Bierbaum, G., & Schmithausen, R. M. (2019). Antibiotic resistant bacteria and resistance genes in biofilms in clinical wastewater networks. International Journal of Hygiene and Environmental Health, 222(4), 655-662. https://doi.org/10.1016/j.ijheh.2019.03.006
Tao, Q., Wu, Q., Zhang, Z., Liu, J., Tian, C., Huang, Z., Malakar, P. K., Pan, Y., & Zhao, Y. (2022). Meta-analysis for the global prevalence of foodborne pathogens exhibiting antibiotic resistance and biofilm formation. Frontiers in Microbiology, 13, 906490. https://doi.org/10.3389/fmicb.2022.906490
Wang, Y., Lu, J., Engelstadter, J., Zhang, S., Ding, P., Mao, L., Yuan, Z., Bond, P. L., & Guo, J. (2020). Non-antibiotic pharmaceuticals enhance the transmission of exogenous antibiotic resistance genes through bacterial transformation. The ISME Journal, 14(8), 2179-2196. https://doi.org/10.1038/s41396-020-0679-2
Wang, Y., Lu, J., Mao, L., Li, J., Yuan, Z., Bond, P. L., & Guo, J. (2021). Non-antibiotic pharmaceuticals promote the transmission of multidrug resistance plasmids through intra- and intergenera conjugation. The ISME Journal, 15(9), 2493-2508. https://doi.org/10.1038/s41396-021-00945-7
Wasistha, W. B., Putri, C. D. R., & Airlangga, R. M. H. (2024). Sebaran bakteri dan profil resistensi antibiotik Enterobacter sp pada saluran pembuangan air di salah satu rumah sakit tipe C Malang. Jurnal Kedokteran Komunitas, 12(1). https://jim.unisma.ac.id/index.php/jkkfk/article/view/25873
WHO (2017). Global antimicrobial resistance surveillance system (GLASS) report: early implementation 2016-2017. Available at: https://pesquisa.bvsalud.org/portal/resource/pt/who-259744
World Health Organization. (2023). Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
Wu, Y., Li, S., Yu, K., Hu, J., Chen, Q., and Sun, W. (2023). Wastewater treatment plant effluents exert different impacts on antibiotic resistome in water and sediment of the receiving river: metagenomic analysis and risk assessment. J. Hazard. Mater. 460:132528. https://doi.org/10.1016/j.jhazmat.2023.132528
Xia, J., Gao, J., & Tang, W. (2016). Nosocomial infection and its molecular mechanisms of antibiotic resistance. Biosci Trends, 10(1), 14-21. https://doi.org/10.5582/bst.2016.01020
Zafar, S., Alimohammadi, M., Moghadam, P. H., & Hadei, M. (2026). Investigating the types of bacterial species with antimicrobial resistance genes in Iran's wastewaters: a systematic review. Science of The Total Environment, 965, 176105. https://doi.org/10.1016/j.scitotenv.2026.181385
Zhang, S., Huang, J., Zhao, Z., Cao, Y., & Li, B. (2020). Hospital wastewater as a reservoir for antibiotic resistance genes: A meta-analysis. Frontiers in Public Health, 8, 574968. https://doi.org/10.3389/fpubh.2020.574968
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Kartini Amelia Putri, Mirryazil Jannah, Nadisa Azzahra , Firdus Firdus, Muhammad Nasir, Alia Rizki (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.



