Bacterial resistance toward broad‐spectrum antibiotics has become a major concern in recent years. The threat posed by the infectious bacteria and the pace with which resistance determinants are transmitted needs to be deciphered. Soil and water contain unique and diverse microbial communities as well as pools of naturally occurring antibiotics resistant genes. Overuse of antibiotics along with poor sanitary practices expose these indigenous microbial communities to antibiotic resistance genes from other bacteria and accelerate the process of acquisition and dissemination. Clinical settings, where most antibiotics are prescribed, are hypothesized to serve as a major hotspot. The predisposition of the surrounding environments to a pool of antibiotic‐resistant bacteria facilitates rapid antibiotic resistance among the indigenous microbiota in the soil, water, and clinical environments via horizontal gene transfer. This provides favorable conditions for the development of more multidrug‐resistant pathogens. Limitations in detecting gene transfer mechanisms have likely left us underestimating the role played by the surrounding environmental hotspots in the emergence of multidrug‐resistant bacteria. This review aims to identify the major drivers responsible for the spread of antibiotic resistance and hotspots responsible for the acquisition of antibiotic resistance genes.

Objective Hospitals serve as hotspots of antibiotic resistance. Despite several studies exploring antibiotic resistance in hospitals, none have explored the resistance profile of soil bacteria from a hospital precinct. This study examined and compared the antibiogram of the soil isolates from a hospital and its affiliated university precinct, to determine if antibiotic resistant bacteria were present closer to the hospital. Results 120 soil samples were collected from JSS Hospital and JSS University in Mysore, India across three consecutive seasons (monsoon, winter and summer). 366 isolates were randomly selected from culture. Antibiotic susceptibility testing was performed on 128 isolates of Pseudomonas (n = 73), Acinetobacter (n = 30), Klebsiella species (n = 15) and Escherichia coli (n = 10). Pseudomonas species exhibited the highest antibiotic resistance. Ticarcillin-clavulanic acid, an extended-spectrum carboxypenicillin antibiotic used to treat moderate-to-severe infections, ranked highest amongst the antibiotics to whom these isolates were resistant (n = 51 out of 73, 69.9%). Moreover, 56.8% (n = 29) were from the hospital and 43.1% (n = 22) were from the university precinct, indicating antibiotic resistant bacteria were closer to the hospital setting. This study highlights the effect of antibiotic usage in hospitals and the influence of anthropogenic activities in the hospital on the dissemination of antibiotic resistance into hospital precinct soil.

Soil contains an enormous diversity of microorganisms and can act as a reservoir of antibiotic resistance determinants. This study identified and compared the bacterial diversity and the antimicrobial resistance profile of clinically-relevant isolates around a newly developed hospital and university precinct. Eight soil samples were collected, genomic DNA was extracted and 16S rRNA gene sequencing was performed. Bacterial isolates cultured from the soil were identified using MALDI-TOF. Antibiotic sensitivity testing (AST) was performed on a subset of isolates. The soil from both precincts were similarly diverse. Phylum Proteobacteria was prevalent in all samples and was the most abundant in one of the hospital sites. Cyanobacteria was abundant in two hospital sites closer to a sewage treatment plant. Bacterial diversity was only significantly different between two of the hospital sites. A total of 22 Gram-negative organisms were isolated by culture. AST revealed that the soil isolates from both precincts exhibited low resistance. The unidentified bacteria closer to the hospital precinct with human interactions possibly hints at the role of anthropogenic activities on the soil microbial diversity. The abundance of Proteobacteria (causing majority of human infections) and Cyanobacteria nearer to the hospital premises, comprising more immunocompromised and immunocompetent individuals, is concerning.