**5. Conclusions**

High prevalence of antibiotic resistance and ARGs were detected in *E. coli* isolates from hospital wastewater both before and even after wastewater treatment. There is a need for inclusion and development of hospital WWTPs which are effective at eliminating antibiotic-resistant bacteria and ARGs. Further studies are needed to identify links between the discharge of antibiotic-resistant bacteria by hospital WWTPs, their occurrence in the nearby environment, and their acquisition by humans when exposed in the environment.

**Acknowledgments:** This work was supported by the Swedish International Development Cooperation Agency (Sida) (grant number SWE-2010-50) and the Vietnamese Government Scholarship for doctoral study of the first author.

**Author Contributions:** Cecilia Stålsby Lundborg, Nguyen Thi Kim Chuc, Pham Thi Lan, Nguyen Quynh Hoa, Ashok J. Tamhankar, and Vishal Diwan conceived and designed the experiments; La Thi Quynh Lien, Nguyen Thi Minh Thoa, and Pham Hong Nhung performed the experiments; La Thi Quynh Lien and Cecilia Stålsby Lundborg in collaboration with all co-authors analysed the data and contributed with reagents/materials/analysis tools; La Thi Quynh Lien wrote the first draft of the manuscript; and all authors further contributed in writing the manuscript.

**Conflicts of Interest:** The authors declare no conflicts of interest.
