Global　transmission　of　resistance　genes　(RGs)　by　non-antibiotic　substances　and　microplastics　(MPs)　pollution　deserves　in-depth　research　and　discussion.　The　impacts　of　the　existence　of　benzethonium　chloride　(BZC)　and　acetaminophen　(APAP)　on　pristine　and　aged　ethylene-vinyl　acetate　copolymer　(EVA)　MPs　in　hospital　wastewater　had　not　been　studied.　In　this　study,　RGs,　microbial　community　composition　and　carbon　source　metabolism　activity　were　explored　on　EVA　plastisphere　in　hospital　wastewater　containing　BZC　and　APAP.　After　aging　treatment,　EVA　MPs　showed　an　increase　in　particle　size,　cracks　on　the　surface　and　changes　in　functional　groups.　Moreover,　aged　EVA　MPs　became　an　excellent　carrier　and　transmitter　of　RGs　and　accelerated　microbial　colonization　after　soaking　in　wastewater　containing　BZC　and　APAP.　The　abundances　of　RGs　in　wastewater　containing　pollutants　were　6.19–665.49　times　higher　than　those　in　wastewater　without　pollutants.　These　results　indicated　that　the　coexistence　of　BZC　and　APAP　had　higher　environmental　risk　compared　with　single　existence.　Furthermore,　quaternary　ammonium　compounds　RGs　were　enriched　in　wastewater　and　on　plastisphere　with　the　presence　of　BZC.　Network　analysis　demonstrated　that　Nitrosomonas　(5.76–25.25　%)　and　pathogen　Legionella　(0.01–40.75　%)　had　high　abundances　in　wastewater　and　on　plastisphere　and　the　potential　to　transfer　multiple　RGs.　This　study　will　fill　the　knowledge　gap　on　the　changes　in　microbial　community　structure,　RGs　transmission　and　carbon　source　metabolism　of　pristine　and　aged　EVA　MPs　in　wastewater　containing　BZC　and　APAP.　©　2025　Elsevier　B.V.