Antimicrobial resistance genes (ARGs) threaten ecosystems and human health, impacting United Nations Sustainable Development Goal 3 (Good Health and Well-being). This review examines ARG occurrence and transfer within the urban water cycle (UWC) from drinking water source to wastewater reuse, highlighting molecular mechanisms and research gaps. Quantitative and metagenomic data reveal that UWC amplifies ARG spread, with plasmid-mediated ARGs rising from ∼ 2.23 % to ∼ 49.51 % and high-risk ARGs increasing from ∼ 0.25 % to ∼ 5.07 %, enhancing horizontal gene transfer in receiving waters. The primary sources of ARGs in UWC are wastewater treatment plants and combined sewage overflows. Multidrug-resistant Pseudomonas aeruginosa in drinking water treatment plant and multidrug-resistant fecal coliforms in wastewater treatment plants should be emphasized. These pose significant risks to both the environment and human health and underscore the urgent need for targeted monitoring and mitigation strategies within the UWC to safeguard public health and aquatic ecosystems. Future research should: (1) map ARG dynamics across the entire UWC, (2) identify hosts of high-risk ARGs and key pathogens, (3) elucidate HGT mechanisms and risk transmission, and (4) develop targeted control technologies for high-risk ARGs at critical UWC points. These insights will inform strategies to ensure water security and curb ARG proliferation in aquatic environments.

中文翻译：

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破译城市水循环中抗菌素耐药基因从水源到再利用的转移：综述

抗菌素耐药基因 （ARG） 威胁着生态系统和人类健康，影响了联合国可持续发展目标 3（良好健康与福祉）。这篇综述研究了城市水循环 （UWC） 中 ARG 的发生和转移，从饮用水源到废水回用，突出了分子机制和研究差距。定量和宏基因组数据显示，UWC 放大了 ARG 的传播，质粒介导的 ARG 从 ∼ 2.23 % 上升到 ∼ 49.51 %，高风险 ARG 从 ∼ 0.25 % 增加到 ∼ 5.07 %，增强了接收水域的水平基因转移。UWC 中 ARG 的主要来源是废水处理厂和合流污水溢流。应强调饮用水处理厂中的多重耐药铜绿假单胞菌和废水处理厂中的多重耐药粪大肠菌群。这些对环境和人类健康都构成了重大风险，并凸显了 UWC 内部迫切需要有针对性的监测和缓解策略，以保护公众健康和水生生态系统。未来的研究应该：（1） 绘制整个 UWC 的 ARG 动态图，（2） 确定高危 ARG 和关键病原体的宿主，（3） 阐明 HGT 机制和风险传播，以及 （4） 在 UWC 关键点为高危 ARG 开发有针对性的控制技术。这些见解将为确保水安全和遏制水生环境中 ARG 扩散的策略提供信息。