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.

Wastewater surveillance is crucial for the epidemiological monitoring of SARS-CoV-2. Various concentration techniques, such as skimmed milk flocculation (SMF) and polyethylene glycol (PEG) precipitation, are employed to isolate the virus effectively. This study aims to compare these two methods and determine the one with the superior recovery rates. From February to December 2021, 24-h wastewater samples were collected from the Ioannina Wastewater Treatment Plant’s inlet and processed using both techniques. Subsequent viral genome isolation and a real-time RT-qPCR detection of SARS-CoV-2 were performed. The quantitative analysis demonstrated a higher detection sensitivity with a PEG-based concentration than SMF. Moreover, when the samples were positive by both methods, PEG consistently yielded higher viral loads. These findings underscore the need for further research into concentration methodologies and the development of precise protocols to enhance epidemiological surveillance through wastewater analysis.