162823 20251017144653.0 doi 10.1016/j.jhazmat.2025.139384 sideral 145238 ART-2025-145238 eng Asghar, Muhammad Umer A metagenomics-based approach to understanding the transmission of healthcare-associated antimicrobial resistance in Pakistan 2025 Access copy available to the general public Unrestricted Hospital environments are critical yet underexamined reservoirs for hazardous antimicrobial resistance (AMR), particularly in lower-middle-income countries (LMICs) where resource constraints often hinder comprehensive surveillance. In this study, we employed 16S rRNA gene sequencing and shotgun metagenomics to characterize the microbiome, resistome, and potential transmission routes across five clinical environments within a hospital in Pakistan: the intensive care unit (ICU), surgical ward (SW), cardiac surgery ward (CSW), cardiac ward (CW), and operating theater (OT). Microbial community analysis revealed compositional similarities among the ICU, SW, and OT, with the ICU emerging as a primary source of microbial dissemination. Species-level profiling identified hospital-associated pathogens such as Acinetobacter baumannii, Klebsiella pneumoniae, and Enterobacter cloacae, and metagenome-assembled genome (MAG) analysis enabled the linkage of antimicrobial resistance genes (ARGs) and mobile genetic elements (MGEs) to specific bacterial hosts. ARGs and MGEs displayed setting-specific patterns, with the SW harboring the highest abundance of ARGs, particularly those conferring resistance to β-lactams and biocides. Insertion sequences were the most prevalent MGEs and were commonly linked to ARGs, indicating potential horizontal gene transfer. Co-occurrence network analysis identified Staphylococcus, Enterococcus, and Escherichia as central hub taxa within the microbial communities of the ICU, SW, and OT, indicating their critical roles in potential ARG transmission. These findings provide critical insights into the environmental transmission dynamics of AMR in LMIC healthcare settings and underscore the urgent need for metagenomics-informed infection control strategies. info:eu-repo/semantics/openAccess by-nc-nd https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Zhai, Yuting Liu, Ting Fan, Peixin Ain, Noor Ul Zaidi, Arsalan Haseeb Tariq, Muhammad Mainar-Jaime, Raul C. Universidad de Zaragoza (orcid)0000-0001-5442-7702 Jeong, Kwangcheol C. 1009 773 Universidad de Zaragoza Dpto. Patología Animal Área Sanidad Animal 496 (2025), 139384 [11 pp.] J. hazard. mater. Journal of Hazardous Materials 0304-3894 5013233 http://zaguan.unizar.es/record/162823/files/texto_completo.pdf Versión publicada 1951039 http://zaguan.unizar.es/record/162823/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:162823 articulos driver 2025-10-17-14:37:09 ARTICLE