{
  "abstract": "Hospital sinks and wastewater streams are hotspots for contamination and colonization with multidrug-resistant Gram-negative bacteria (MDR-GNB). While hospital water systems may facilitate MDR-GNB transmission during outbreaks, longitudinal population dynamics of environmental MDR-GNB and their long-term relationship with patient isolates remain unclear. Here we aimed to characterize the diversity and abundance of MDR-GNB within the hospital built environment and evaluate their relationship with clinical isolates. We performed nanopore sequencing on MDR-GNB cultured from sink drains (n=523) and wastewater (n=146) at a New York City hospital between March-August 2023. We assessed spatial and longitudinal genomic strain and plasmid dynamics and quantified relatedness to historical clinical isolates from the same hospital (n=602). Sink drains (54-73%) and wastewater (100%) demonstrated widespread, longitudinal colonization with MDR-GNB, driven primarily by carbapenem-resistant GNB including opportunistic organisms and Enterobacterales encoding blaKPC. While bacterial colonization differed across environmental niches, we identified both MDR-GNB strains and resistance plasmids that were shared between clinical and environmental sources, as well a distinct interplay between clinical and wastewater versus sink drain samples. This study supports the role of hospital plumbing as an important reservoir for clinically relevant MDR-GNB, but highlights differences across environmental sources, which may impact surveillance approaches.",
  "abstract_shown": true,
  "affiliations": [
    "Children's Hospital of Philadelphia; University of Pennsylvania Perelman School of Medicine"
  ],
  "article_type": "New results",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "M. K. Annavajhala"
    },
    {
      "name": "T. W. Hokunson"
    },
    {
      "name": "K. Terzoglou"
    },
    {
      "name": "A.-C. Uhlemann"
    },
    {
      "name": "A. Gomez-Simmonds"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/74t3t1r6haqex.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.07.20.739580",
  "fulltext_url": "https://www.biorxiv.org/content/10.64898/2026.07.20.739580v2.full",
  "id": "74t3t1r6haqex",
  "issns": [],
  "landing_url": "https://www.biorxiv.org/content/10.64898/2026.07.20.739580v2",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "biorxiv",
      "microbiology"
    ],
    [
      "openalex",
      "2726|Antibiotic Resistance in Bacteria"
    ]
  ],
  "openalex": "W7169768581",
  "pdf_url": "https://www.biorxiv.org/content/10.64898/2026.07.20.739580v2.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-20",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/74t3t1r6haqex.ris",
  "sources": [
    {
      "first_seen": "2026-11-10T12:21:31Z",
      "native_id": "10.64898/2026.07.20.739580",
      "source": "biorxiv",
      "url": "https://www.biorxiv.org/content/10.64898/2026.07.20.739580v2"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "biorxiv:microbiology",
      "subfield": "microbiology"
    }
  ],
  "title": "Interconnected reservoirs of multidrug-resistant bacteria and plasmids within hospital plumbing infrastructure",
  "title_text": "Interconnected reservoirs of multidrug-resistant bacteria and plasmids within hospital plumbing infrastructure",
  "type": "preprint",
  "updated_at": "2026-11-10T12:21:31Z",
  "url": "https://research.draconitic.com/paper/74t3t1r6haqex",
  "venue": "bioRxiv",
  "versions": []
}