Effective Treatment Strategies for the Removal of Antibiotic-Resistant Bacteria, Antibiotic-Resistance Genes, and Antibiotic Residues in the Effluent From Wastewater Treatment Plants Receiving Municipal, Hospital, and Domestic Wastewater: Protocol for a Systematic Review (Preprint)

BACKGROUND The widespread and unrestricted use of antibiotics has led to the emergence and spread of antibiotic-resistant bacteria (ARB), antibiotic-resistance genes (ARGs), and antibiotic residues in the environment. Conventional wastewater treatment plants (WWTPs) are not designed for effective and adequate removal of ARB, ARGs, and antibiotic residues, and therefore, they play an important role in the dissemination of antimicrobial resistance (AMR) in the natural environment. OBJECTIVE We will conduct a systematic review to determine the most effective treatment strategies for the removal of ARB, ARGs, and antibiotic residues from the treated effluent disposed into the environment from WWTPs that receive municipal, hospital, and domestic discharge. METHODS We will search the MEDLINE, EMBASE, Web of Science, World Health Organization Global Index Medicus, and ProQuest Environmental Science Collection databases for full-text peer-reviewed journal articles published between January 2001 and December 2020. We will select only articles published in the English language. We will include studies that measured (1) the presence, concentration, and removal rate of ARB/ARGs going from WWTP influent to effluent, (2) the presence, concentration, and types of antibiotics in the effluent, and (3) the possible selection of ARB in the effluent after undergoing treatment processes in WWTPs. At least two independent reviewers will extract data and perform risk of bias assessment. An acceptable or narrative synthesis method will be followed to synthesize the data and present descriptive characteristics of the included studies in a tabular form. The study has been approved by the Ethics Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh (protocol number: PR-20113). RESULTS This protocol outlines our proposed methodology for conducting a systematic review. Our results will provide an update to the existing literature by searching additional databases. CONCLUSIONS Findings from our systematic review will inform the planning of proper treatment methods that can effectively reduce the levels of ARB, ARGs, and residual antibiotics in effluent, thus lowering the risk of the environmental spread of AMR and its further transmission to humans and animals. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/33365

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Effective Treatment Strategies for the Removal of Antibiotic-Resistant Bacteria, Antibiotic-Resistance Genes, and Antibiotic Residues in the Effluent From Wastewater Treatment Plants Receiving Municipal, Hospital, and Domestic Wastewater: Protocol for a Systematic Review

JMIR Research Protocols ◽

10.2196/33365 ◽

2021 ◽

Vol 10 (11) ◽

pp. e33365

Author(s):

Mahbub-Ul Alam ◽

Sharika Ferdous ◽

Ayse Ercumen ◽

Audrie Lin ◽

Abul Kamal ◽

...

Keyword(s):

Systematic Review ◽

Antibiotic Resistance ◽

Wastewater Treatment ◽

Wastewater Treatment Plants ◽

Treatment Strategies ◽

Antibiotic Resistance Genes ◽

Resistant Bacteria ◽

Antibiotic Residues ◽

Municipal Hospital ◽

Antibiotic Resistant

Background The widespread and unrestricted use of antibiotics has led to the emergence and spread of antibiotic-resistant bacteria (ARB), antibiotic-resistance genes (ARGs), and antibiotic residues in the environment. Conventional wastewater treatment plants (WWTPs) are not designed for effective and adequate removal of ARB, ARGs, and antibiotic residues, and therefore, they play an important role in the dissemination of antimicrobial resistance (AMR) in the natural environment. Objective We will conduct a systematic review to determine the most effective treatment strategies for the removal of ARB, ARGs, and antibiotic residues from the treated effluent disposed into the environment from WWTPs that receive municipal, hospital, and domestic discharge. Methods We will search the MEDLINE, EMBASE, Web of Science, World Health Organization Global Index Medicus, and ProQuest Environmental Science Collection databases for full-text peer-reviewed journal articles published between January 2001 and December 2020. We will select only articles published in the English language. We will include studies that measured (1) the presence, concentration, and removal rate of ARB/ARGs going from WWTP influent to effluent, (2) the presence, concentration, and types of antibiotics in the effluent, and (3) the possible selection of ARB in the effluent after undergoing treatment processes in WWTPs. At least two independent reviewers will extract data and perform risk of bias assessment. An acceptable or narrative synthesis method will be followed to synthesize the data and present descriptive characteristics of the included studies in a tabular form. The study has been approved by the Ethics Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh (protocol number: PR-20113). Results This protocol outlines our proposed methodology for conducting a systematic review. Our results will provide an update to the existing literature by searching additional databases. Conclusions Findings from our systematic review will inform the planning of proper treatment methods that can effectively reduce the levels of ARB, ARGs, and residual antibiotics in effluent, thus lowering the risk of the environmental spread of AMR and its further transmission to humans and animals. International Registered Report Identifier (IRRID) PRR1-10.2196/33365

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Technologies in Wastewater Treatment Plants for the Removal of Antibiotics, Resistant Bacteria and Antibiotic Resistance Genes: a Review of the Current Literature

Ingenieria y Universidad ◽

10.11144/javeriana.iyu26.twtp ◽

2021 ◽

Vol 26 ◽

Author(s):

Maria Camila Zapata Zúñiga ◽

Miguel Angel Parra-Pérez ◽

Johan Alexander Álvarez-Berrio ◽

Nidia Isabel Molina-Gómez

Keyword(s):

Antibiotic Resistance ◽

Wastewater Treatment ◽

Resistance Genes ◽

Wastewater Treatment Plants ◽

Antibiotic Resistance Genes ◽

Resistant Bacteria ◽

Sources Of Information ◽

Antibiotic Resistant Bacteria ◽

Antibiotic Resistant ◽

Treatment Processes

This study aimed to evaluate the efficiency of technologies for removing antibiotics, antibiotic-resistant bacteria and their antibiotic resistance genes, and the countries where they have been developed. For this purpose, was conducted a systematic review to identify the tertiary treatments to remove the above-mentioned pollutants. The ScienceDirect and Scopus databases were used as sources of information, taking into account only experimental research from 2006 to 2019 and technologies with removal rates higher than 70% to the information analyses. From the analysis of 9 technologies evaluated, in a set of 47 investigations, photo-Fenton, and electrochemical treatments were found to be the most efficient in the removal of antibiotics; gamma radiation and photocatalysis with TiO2 and UV revealed better results in the removal of resistant microbial agents and their resistance genes, with efficiencies of 99.9%. As one of the largest producers and consumers of antibiotics, China appears to be the country with the most scientific research on the area. The importance of innovation in wastewater treatment processes to achieve better results in the remotion of antibiotics, antibiotic-resistant bacteria, and their resistance genes is highlighted, given the effects on the aquatic ecosystems and public health.

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Do wastewater treatment plants increase antibiotic resistant bacteria or genes in the environment? Protocol for a systematic review

10.7287/peerj.preprints.27727 ◽

2019 ◽

Author(s):

Daloha Rodríguez-Molina ◽

Petra Mang ◽

Heike Schmitt ◽

Mariana Carmen Chifiriuc ◽

Katja Radon ◽

...

Keyword(s):

Systematic Review ◽

Antibiotic Resistance ◽

Wastewater Treatment ◽

Water Samples ◽

Wastewater Treatment Plants ◽

Resistant Bacteria ◽

Process Data ◽

Antibiotic Resistant Bacteria ◽

Antibiotic Resistant ◽

Antimicrobial Resistance Genes

Background. Antibiotic resistance is a global public health threat. Water from human activities is collected at wastewater treatment plants where processes often do not sufficiently neutralize antibiotic resistant bacteria and genes, which are further shed into the local environment. This protocol outlines the steps to conduct a systematic review based on the Population, Exposure, Comparator and Outcome (PECO) framework, aiming at answering the question Are antimicrobial-resistant enterobacteriaceae and antimicrobial resistance genes present (O) in air and water samples (P) taken either near or downstream or downwind or down-gradient from wastewater treatment plants (E), as compared to air and water samples taken either further away or upstream or upwind or up-gradient from such wastewater treatment plant (C)? Presence of antimicrobial-resistant bacteria and genes will be quantitatively measured by extracting their prevalence or concentration, depending on the reviewed study. Methods. We will search PubMed, EMBASE, the Cochrane database and Web of Science for original articles published from 01-Jan-2000 to 03-Sep-2018 with language restriction. Articles will undergo a relevance and a design screening process. Data from eligible articles will be extracted by two independent reviewers. Further, we will perform a risk of bias assessment using a decision matrix. We will synthesize and present results in narrative and tabular form and will perform a meta-analysis if heterogeneity of results allows it. Discussion. Antibiotic resistance in environmental samples around wastewater treatment plants may pose a risk of exposure to workers and nearby residents. Results from the systematic review outlined in this protocol will allow to estimate the extend of exposure, to inform policy making and help to design future studies.

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Do wastewater treatment plants increase antibiotic resistant bacteria or genes in the environment? Protocol for a systematic review

10.7287/peerj.preprints.27727v1 ◽

2019 ◽

Author(s):

Daloha Rodríguez-Molina ◽

Petra Mang ◽

Heike Schmitt ◽

Mariana Carmen Chifiriuc ◽

Katja Radon ◽

...

Keyword(s):

Systematic Review ◽

Antibiotic Resistance ◽

Wastewater Treatment ◽

Water Samples ◽

Wastewater Treatment Plants ◽

Resistant Bacteria ◽

Process Data ◽

Antibiotic Resistant Bacteria ◽

Antibiotic Resistant ◽

Antimicrobial Resistance Genes

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Do wastewater treatment plants increase antibiotic resistant bacteria or genes in the environment? Protocol for a systematic review

Systematic Reviews ◽

10.1186/s13643-019-1236-9 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Daloha Rodríguez-Molina ◽

Petra Mang ◽

Heike Schmitt ◽

Mariana Carmen Chifiriuc ◽

Katja Radon ◽

...

Keyword(s):

Systematic Review ◽

Antibiotic Resistance ◽

Wastewater Treatment ◽

Water Samples ◽

Wastewater Treatment Plants ◽

Resistant Bacteria ◽

Process Data ◽

Antibiotic Resistant Bacteria ◽

Antibiotic Resistant ◽

Antimicrobial Resistance Genes

Abstract Background Antibiotic resistance is a global public health threat. Water from human activities is collected at wastewater treatment plants where processes often do not sufficiently neutralize antibiotic resistant bacteria and genes, which are further shed into the local environment. This protocol outlines the steps to conduct a systematic review based on the Population, Exposure, Comparator and Outcome (PECO) framework, aiming at answering the question “Are antimicrobial-resistant enterobacteriaceae and antimicrobial resistance genes present (O) in air and water samples (P) taken either near or downstream or downwind or down-gradient from wastewater treatment plants (E), as compared to air and water samples taken either further away or upstream or upwind or up-gradient from such wastewater treatment plant (C)?” Presence of antimicrobial-resistant bacteria and genes will be quantitatively measured by extracting their prevalence or concentration, depending on the reviewed study. Methods We will search PubMed, EMBASE, the Cochrane database and Web of Science for original articles published from 1 Jan 2000 to 3 Sep 2018 with language restriction. Articles will undergo a relevance and a design screening process. Data from eligible articles will be extracted by two independent reviewers. Further, we will perform a risk of bias assessment using a decision matrix. We will synthesize and present results in narrative and tabular form and will perform a meta-analysis if heterogeneity of results allows it. Discussion Antibiotic resistance in environmental samples around wastewater treatment plants may pose a risk of exposure to workers and nearby residents. Results from the systematic review outlined in this protocol will allow to estimate the extend of exposure, to inform policy making and help to design future studies.

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Monitoring and assessing the impact of wastewater treatment on release of both antibiotic-resistant bacteria and their typical genes in a Chinese municipal wastewater treatment plant

Environmental Science Processes & Impacts ◽

10.1039/c4em00208c ◽

2014 ◽

Vol 16 (8) ◽

pp. 1930-1937 ◽

Cited By ~ 28

Author(s):

Qing-Bin Yuan ◽

Mei-Ting Guo ◽

Jian Yang

Keyword(s):

Antibiotic Resistance ◽

Wastewater Treatment ◽

Wastewater Treatment Plant ◽

Municipal Wastewater ◽

Wastewater Treatment Plants ◽

Treatment Plant ◽

Resistant Bacteria ◽

Municipal Wastewater Treatment ◽

Antibiotic Resistant ◽

The Impact

Wastewater treatment plants (WWTPs) are important hotspots for the spread of antibiotic resistance.

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Association between antibiotic residues, antibiotic resistant bacteria and antibiotic resistance genes in anthropogenic wastewater – An evaluation of clinical influences

Chemosphere ◽

10.1016/j.chemosphere.2019.125032 ◽

2020 ◽

Vol 241 ◽

pp. 125032 ◽

Cited By ~ 16

Author(s):

A.M. Voigt ◽

N. Zacharias ◽

C. Timm ◽

F. Wasser ◽

E. Sib ◽

...

Keyword(s):

Antibiotic Resistance ◽

Resistance Genes ◽

Antibiotic Resistance Genes ◽

Resistant Bacteria ◽

Antibiotic Residues ◽

Antibiotic Resistant Bacteria ◽

Antibiotic Resistant

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Drug resistance in airborne bacteria isolated from waste management and wastewater treatment plants in Olsztyn

E3S Web of Conferences ◽

10.1051/e3sconf/201910000066 ◽

2019 ◽

Vol 100 ◽

pp. 00066 ◽

Cited By ~ 2

Author(s):

Jacek Potorski ◽

Izabela Koniuszewska ◽

Małgorzata Czatzkowska ◽

Monika Harnisz

Keyword(s):

Antibiotic Resistance ◽

Wastewater Treatment ◽

Waste Management ◽

Wastewater Treatment Plants ◽

Antibiotic Resistance Genes ◽

Resistant Bacteria ◽

Bacterial Strains ◽

Bacterial Counts ◽

Air Samples ◽

Processing Line

Wastewater treatment plants (WWTPs) and municipal waste management plants (MWMPs) emit bioaerosols containing potentially pathogenic biological components which post a threat for human health. Microbiological monitoring supports evaluations of the antibiotic resistance (AR) of airborne microorganisms and the relevant health risks. The aim of this study was to analyze the microbiological quality of air sampled in a WWTP and MWMP in Olsztyn based on total bacterial counts, the presence of bacteria resistant to three antibiotic classes (beta-lactams, tetracyclines and chloramphenicol) and genes encoding resistance to these antibiotics (blaTEM, blaSHV, blaCMY-2, blaAmpC, tet(M), tet(A), tet(X), tet(B), cmlA, floR, fexA, fexB and catA1 ). Bacterial counts were higher in air samples collected from the MWMP (~104 CFU/m3) than from the WWTP (101–103 CFU/m3). A similar trend was noted in the counts of antibiotic resistant bacteria (ARB). The abundance of ARB did not exceed 1.7 x 102 CFU/m3 in WWTP samples, but was higher at up to 4.2 x 103 CFU/m3 in MWMP samples. Bacteria resistant to doxycycline were least prevalent in the analyzed ARB. In the group of 49 tested bacterial strains, 44 harbored at least one of the analyzed antibiotic resistance genes (ARGs). A comparison of ARGs in all bacterial strains isolated from WWTP and MWMP air samples revealed the highest diversity and prevalence of ARGs in the samples collected in the mechanical segment of the waste processing line in MWMP and the biological segment of the wastewater processing line in WWTP. The results of this study point to high microbiological contamination of air in MWMPs and WWTPs which are reservoirs of ARB and ARGs and potential sources of AR.

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The Role of Urban Wastewater in the Environmental Transmission of Antimicrobial Resistance: The Current Situation in Italy (2010–2019)

Microorganisms ◽

10.3390/microorganisms8101567 ◽

2020 ◽

Vol 8 (10) ◽

pp. 1567

Author(s):

Francesco Triggiano ◽

Carla Calia ◽

Giusy Diella ◽

Maria Teresa Montagna ◽

Osvalda De Giglio ◽

...

Keyword(s):

Antibiotic Resistance ◽

Wastewater Treatment ◽

Wastewater Treatment Plants ◽

Geographical Area ◽

National Level ◽

Antibiotic Resistance Genes ◽

Resistant Bacteria ◽

Urban Wastewater ◽

New Treatment ◽

Urban Wastewater Treatment

Scientific studies show that urban wastewater treatment plants (UWWTP) are among the main sources of release of antibiotics, antibiotic resistance genes (ARG) and antibiotic-resistant bacteria (ARB) into the environment, representing a risk to human health. This review summarizes selected publications from 1 January 2010 to 31 December 2019, with particular attention to the presence and treatment of ARG and ARB in UWWTPs in Italy. Following a brief introduction, the review is divided into three sections: (i) phenotypic assessment (ARB) and (ii) genotypic assessment (ARG) of resistant microorganisms, and (iii) wastewater treatment processes. Each article was read entirely to extract the year of publication, the geographical area of the UWWTP, the ARB and ARG found, and the type of disinfection treatment used. Among the ARB, we focused on the antibiotic resistance of Escherichia coli, Klebsiella pneumoniae, and Enterococci in UWWTP. The results show that the information presented in the literature to date is not exhaustive; therefore, future scientific studies at the national level are needed to better understand the spread of ARB and ARG, and also to develop new treatment methods to reduce this spread.

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Identification of Selected Antibiotic Resistance Genes in Two Different Wastewater Treatment Plant Systems in Poland: A Preliminary Study

Molecules ◽

10.3390/molecules25122851 ◽

2020 ◽

Vol 25 (12) ◽

pp. 2851 ◽

Cited By ~ 1

Author(s):

Magdalena Pazda ◽

Magda Rybicka ◽

Stefan Stolte ◽

Krzysztof Piotr Bielawski ◽

Piotr Stepnowski ◽

...

Keyword(s):

Antibiotic Resistance ◽

Wastewater Treatment ◽

Resistance Genes ◽

Wastewater Treatment Plants ◽

Treatment Plant ◽

Antibiotic Resistance Genes ◽

Resistant Bacteria ◽

Clear Trend ◽

Resistance Determinants ◽

Final Effluent

Antibiotic resistance is a growing problem worldwide. The emergence and rapid spread of antibiotic resistance determinants have led to an increasing concern about the potential environmental and public health endangering. Wastewater treatment plants (WWTPs) play an important role in this phenomenon since antibacterial drugs introduced into wastewater can exert a selection pressure on antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs). Therefore, WWTPs are perceived as the main sources of antibiotics, ARB and ARG spread in various environmental components. Furthermore, technological processes used in WWTPs and its exploitation conditions may influence the effectiveness of antibiotic resistance determinants’ elimination. The main aim of the present study was to compare the occurrence of selected tetracycline and sulfonamide resistance genes in raw influent and final effluent samples from two WWTPs different in terms of size and applied biological wastewater treatment processes (conventional activated sludge (AS)-based and combining a conventional AS-based method with constructed wetlands (CWs)). All 13 selected ARGs were detected in raw influent and final effluent samples from both WWTPs. Significant ARG enrichment, especially for tet(B, K, L, O) and sulIII genes, was observed in conventional WWTP. The obtained data did not show a clear trend in seasonal fluctuations in the abundance of selected resistance genes in wastewaters.

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