Antibiotic resistomes in drinking water sources across a large geographical scale: Multiple drivers and co-occurrence with opportunistic bacterial pathogens.

Antibiotic resistance genes (ARGs) can survive the water treatment process. However, the prevalence patterns, key drivers, and relationships with opportunistic pathogens of the antibiotic resistome harbored in drinking water sources remain unclear. Herein, 53 drinking water samples collected across a large geographical scale in China were characterized based on ARGs, mobile genetic elements (MGEs), bacterial communities, antibiotics, and opportunistic bacterial pathogens. A total of 265 unique ARGs and MGEs were detected by high-throughput quantitative polymerase chain reaction (HT-qPCR), and 101 genes were shared among over 50% of samples. ARG abundance was higher in rivers than in reservoirs or groundwater, and ARG similarity showed a distance-decay relationship at the >4 000 km scale. Four out of the five detected opportunistic pathogens (i.e., Escherichia coli, Mycobacterium spp., Clostridium perfringens, and Bacillus cereus group) were potential hosts of ARGs. Based on multivariate statistics, our results demonstrated that the factors influencing the antibiotic resistome in drinking water sources were multiple and interactive. The bacterial community greatly contributed to ARG structure, and antibiotic concentrations and MGEs also affected ARG proliferation. The structural equation model indicated that geographical location and sample types (i.e., river, reservoir, and groundwater) had indirect effects on ARGs by changing the bacterial community and antibiotic concentration. Holistic consideration of natural and anthropogenic factors is recommended to understand antibiotic resistome variation in drinking water sources at a large geographical scale. Furthermore, large-scale diverse samples are suggested to minimize the potential influence of accident or stochasticity. Our findings provide insight into water quality risks induced by drinking water antibiotic resistomes.