Antimicrobial resistance (AMR) is a major threat to global health. Understanding the emergence, evolution, and transmission of individual antibiotic resistance genes (ARGs) is essential to develop sustainable strategies combatting this threat. Here, we use metagenomic sequencing to analyse ARGs in 757 sewage samples from 243 cities in 101 countries, collected from 2016 to 2019. We find regional patterns in resistomes, and these differ between subsets corresponding to drug classes and are partly driven by taxonomic variation. The genetic environments of 49 common ARGs are highly diverse, with most common ARGs carried by multiple distinct genomic contexts globally and sometimes on plasmids. Analysis of flanking sequence revealed ARG-specific patterns of dispersal limitation and global transmission. Our data furthermore suggest certain geographies are more prone to transmission events and should receive additional attention.

抗生素耐药性（AMR）是全球健康的主要威胁。了解单个抗生素抗性基因 (ARG) 的出现、进化和传播对于制定应对这一威胁的可持续战略至关重要。在这里，我们使用宏基因组测序来分析 2016 年至 2019 年收集的来自 101 个国家 243 个城市的 757 个污水样本中的 ARG。我们发现了耐药组的区域模式，这些模式在与药物类别相对应的子集之间存在差异，部分是由分类变异驱动的。 49 种常见 ARG 的遗传环境高度多样化，大多数常见 ARG 由全球多个不同的基因组环境携带，有时在质粒上携带。侧翼序列分析揭示了 ARG 特定的扩散限制和全球传播模式。我们的数据还表明，某些地区更容易发生传播事件，应受到额外关注。