Abstract
The main objective of this review was to examine the health risk indicators related to the dissemination of antibiotic resistance genes in the rural aquatic environment, focusing on the Babylon Governorate. The significance of this topic is derived from the fact that the problem of antibiotic resistance exists not only in the treatment pathway in healthcare but in an environment that is interconnected to humans, animals, and water because of the growing presence of wastewater, animal waste, agricultural runoff, and disposal of pharmaceuticals in water systems. A descriptive-analytical method was used to review the scientific literature that has explored the occurrence of resistant bacteria, resistance genes, and antibiotic residues in freshwater, wastewater, and water sources impacted by human activities. The analysis was conducted to identify the sources of the resistance factor that enters water, the genetic classes most linked to the most frequently used antibiotics, the mechanisms for gene survival and transfer, and factors that enhance the risk of human and animal exposure. There are indications that the aquatic environment can serve as a reservoir and a facilitator for the dissemination of resistance, notably in case of organic contamination, selection pressure, and transposable genetic elements. However, the presence of a resistance gene does not necessarily mean that pathogenic bacteria or that humans have been infected are present. Must be used in conjunction with water quality indicators, bacterial isolation, susceptibility testing and the nature of use of the source. The review recommends that risk assessment in Babylon Governorate needs to be done regularly and in a standardized manner, through local field studies, better management of waste water and sewage, rational use of antibiotics and institutional cooperation with One Health approach into consideration, and implementation of preventive measures taking into account the safety and living conditions of the population.