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Antibiotic Resistance in Wastewater and Its Treatment

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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 33817

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Dr. Lucia Bírošová

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Faculty of Chemical and Food Technology, Slovak University of Technology, 581243 Bratislava, Slovakia
Interests: environmental and food microbiology; antibiotic resistance; molecular biology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The phenomenon of antibiotic resistance is still an emerging problem worldwide. It makes the treatment of common diseases difficult. It also increases financial demands for treatment. So, antibiotic resistance is a global socio-economic problem. Wastewater contains a mixture of different pharmaceuticals and bacteria, and so it represents an important hotspot for the development and dissemination of antibiotic-resistant bacteria and antibiotic resistance genes. These bacteria together with their genes can spread further into the environment and food chain, endangering humans and animals. At this point, it is important to focus on innovative technologies which help us to eliminate the problem of antibiotic resistance in wastewater. Therefore, the main subject of this Special Issue includes the monitoring and characterization of antibiotic resistance in wastewater and its recipients, as well as the description of novel technologies for wastewater treatment with a view to eliminating the problem of antibiotic resistance. This Special Issue seeks manuscript submissions that further our understanding of antimicrobial resistance in wastewater and which design novel strategies to solve this problem.

Dr. Lucia Bírošová
Guest Editor

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Keywords

antibiotics
wastewater
microorganisms
antibiotic resistance
wastewater treatment plant
treantment technologies
recipient surface water
environment
water pollution

Published Papers (10 papers)

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12 pages, 1222 KiB

Open AccessArticle

Nanofiltration as an Efficient Tertiary Wastewater Treatment: Elimination of Total Bacteria and Antibiotic Resistance Genes from the Discharged Effluent of a Full-Scale Wastewater Treatment Plant

by Micaela Oliveira, Inês Carvalho Leonardo, Ana Filipa Silva, João Goulão Crespo, Mónica Nunes and Maria Teresa Barreto Crespo

Antibiotics 2022, 11(5), 630; https://doi.org/10.3390/antibiotics11050630 - 6 May 2022

Cited by 4 | Viewed by 2631

Abstract

Wastewater reuse for agricultural irrigation still raises important public health issues regarding its safety, due to the increasing presence of emerging contaminants, such as antibiotic resistant bacteria and genes, in the treated effluents. In this paper, the potential for a commercial Desal 5 DK nanofiltration membrane to be used as a tertiary treatment in the wastewater treatment plants for a more effective elimination of these pollutants from the produced effluents was assessed on laboratory scale, using a stainless steel cross-flow cell. The obtained results showed high concentrations of total bacteria and target carbapenem and (fluoro)quinolone resistance genes (bla_KPC, bla_OXA-48, bla_NDM, bla_IMP, bla_VIM, qnrA, qnrB and qnrS) not only in the discharged, but also in the reused, effluent samples, which suggests that their use may not be entirely safe. Nevertheless, the applied nanofiltration treatment achieved removal rates superior to 98% for the total bacteria and 99.99% for all the target resistance genes present in both DNA and extracellular DNA fractions, with no significant differences for these microbiological parameters between the nanofiltered and the control tap water samples. Although additional studies are still needed to fully optimize the entire process, the use of nanofiltration membranes seems to be a promising solution to substantially increase the quality of the treated wastewater effluents. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Wastewater and Its Treatment)

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9 pages, 1323 KiB

Open AccessArticle

Antimicrobial Resistance Patterns and Clonal Distribution of E. coli, Enterobacter spp. and Acinetobacter spp. Strains Isolated from Two Hospital Wastewater Plants

by Miguel Galarde-López, Maria Elena Velazquez-Meza, Miriam Bobadilla-del-Valle, Patricia Cornejo-Juárez, Berta Alicia Carrillo-Quiroz, Alfredo Ponce-de-León, Alejandro Sassoé-González, Pedro Saturno-Hernández and Celia Mercedes Alpuche-Aranda

Antibiotics 2022, 11(5), 601; https://doi.org/10.3390/antibiotics11050601 - 29 Apr 2022

Cited by 6 | Viewed by 2507

Abstract

The objective of this study was to determine the presence and persistence of antimicrobial-resistant enterobacteria and their clonal distribution in hospital wastewater. A descriptive cross-sectional study was carried out in wastewater from two Mexico City tertiary level hospitals. In February and March of 2020, eight wastewater samples were collected and 26 isolates of enterobacteria were recovered, 19 (73.1%) isolates were identified as E. coli, 5 (19.2%) as Acinetobacter spp. and 2 (7.7%) as Enterobacter spp. Antimicrobial susceptibility profiles were performed using the VITEK 2^® automated system and bacterial identification was performed by the Matrix-Assisted Laser Desorption/Ionization-Time of Flight mass spectrometry (MALDI-TOF MS^®). ESBL genes were detected by polymerase chain reaction (PCR) and clonal distributions of isolates were determined by pulsed-field gel electrophoresis (PFGE). E. coli susceptibility to different classes of antimicrobials was analyzed and resistance was mainly detected as ESBLs and fluoroquinolones. One E. coli strain was resistant to doripenem, ertapenem, imipenem and meropenem. The analysis by PCR showed the presence of specific β-lactamases resistance genes (bla_KPC, bla_CTX-M). The PFGE separated the E. coli isolates into 19 different patterns (A–R). PFGE results of Acinetobacter spp. showed the presence of a majority clone A. Surveillance of antimicrobial resistance through hospital wastewater is an important tool for early detection of clonal clusters of clinically important bacteria with potential for dissemination. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Wastewater and Its Treatment)

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18 pages, 1605 KiB

Open AccessArticle

by Elizabeth Liedhegner, Brandon Bojar, Rachelle E. Beattie, Caitlin Cahak, Krassimira R. Hristova and Troy Skwor

Antibiotics 2022, 11(2), 260; https://doi.org/10.3390/antibiotics11020260 - 17 Feb 2022

Cited by 6 | Viewed by 3233

Abstract

The World Health Organization has identified antibiotic resistance as one of the largest threats to human health and food security. In this study, we compared antibiotic resistance patterns between ESBL-producing Escherichia coli from human clinical diseases and cefotaxime-resistant environmental strains, as well as their potential to be pathogenic. Antibiotic susceptibility was tested amongst clinical isolates (n = 11), hospital wastewater (n = 22), and urban wastewater (n = 36, both influent and treated effluents). Multi-drug resistance predominated (>70%) among hospitalwastewater and urban wastewater influent isolates. Interestingly, isolates from clinical and urban treated effluents showed similar multi-drug resistance rates (~50%). Most hospital wastewater isolates were Phylogroup A, while clinical isolates were predominately B2, with a more diverse phylogroup population in urban wastewater. ESBL characterization of cefotaxime-resistant populations identified bla_CTX-M-1 subgroup as the most common, whereby bla_KPC was more associated with ceftazidime and ertapenem resistance. Whole-genome sequencing of a carbapenemase-producing hospital wastewater E. coli strain revealed plasmid-mediated bla_KPC-2. Among cefotaxime-resistant populations, over 60% of clinical and 30% of treated effluent E. coli encoded three or more virulence genes exhibiting a pathogenic potential. Together, the similarity among treated effluent E. coli populations and clinical strains suggest effluents could serve as a reservoir for future multi-drug resistant E. coli clinical infections. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Wastewater and Its Treatment)

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13 pages, 939 KiB

Open AccessArticle

Persistence of Antibiotic-Resistant Escherichia coli Strains Belonging to the B2 Phylogroup in Municipal Wastewater under Aerobic Conditions

by Hui Xie, Yoshitoshi Ogura and Yoshihiro Suzuki

Antibiotics 2022, 11(2), 202; https://doi.org/10.3390/antibiotics11020202 - 4 Feb 2022

Cited by 4 | Viewed by 2098

Abstract

Escherichia coli is classified into four major phylogenetic groups (A, B1, B2, and D) that are associated with antibiotic resistance genes. Although antibiotic-resistant E. coli is commonly detected in municipal wastewater, little is known about the relationship between the phylogenetic groups and antibiotic-resistant E. coli in wastewater. In this study, the survival of E. coli in wastewater and the changes to the relationships between each phylogroup and the antibiotic-resistant profiles of E. coli isolates from wastewater were investigated under aerobic conditions for 14 days. The isolates were classified into the phylogroups A, B1, B2, and D or others by multiplex PCR. In addition, the susceptibility of the isolates to 11 antibiotics was assessed with the minimum inhibitory concentration (MIC) assay. While E. coli counts decreased in the wastewater with time under aerobic conditions, the prevalence of phylogroup B2 had increased to 73% on day 14. Furthermore, the MIC assay revealed that the abundance of antibiotic-resistant E. coli also increased on day 14. After batch-mixing the experiments under aerobic conditions, the surviving antibiotic-resistant E. coli included mainly multidrug-resistant and beta-lactamase-producing isolates belonging to phylogroup B2. These results suggest that the phylogroup B2 isolates that have acquired antibiotic resistance had a high survivability in the treated wastewater. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Wastewater and Its Treatment)

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13 pages, 1194 KiB

Open AccessEditor’s ChoiceArticle

Environmental and Pathogenic Carbapenem Resistant Bacteria Isolated from a Wastewater Treatment Plant Harbour Distinct Antibiotic Resistance Mechanisms

by Micaela Oliveira, Inês Carvalho Leonardo, Mónica Nunes, Ana Filipa Silva and Maria Teresa Barreto Crespo

Antibiotics 2021, 10(9), 1118; https://doi.org/10.3390/antibiotics10091118 - 16 Sep 2021

Cited by 12 | Viewed by 3465

Abstract

Wastewater treatment plants are important reservoirs and sources for the dissemination of antibiotic resistance into the environment. Here, two different groups of carbapenem resistant bacteria—the potentially environmental and the potentially pathogenic—were isolated from both the wastewater influent and discharged effluent of a full-scale wastewater treatment plant and characterized by whole genome sequencing and antibiotic susceptibility testing. Among the potentially environmental isolates, there was no detection of any acquired antibiotic resistance genes, which supports the idea that their resistance mechanisms are mainly intrinsic. On the contrary, the potentially pathogenic isolates presented a broad diversity of acquired antibiotic resistance genes towards different antibiotic classes, especially β-lactams, aminoglycosides, and fluoroquinolones. All these bacteria showed multiple β-lactamase-encoding genes, some with carbapenemase activity, such as the bla_KPC-type genes found in the Enterobacteriaceae isolates. The antibiotic susceptibility testing assays performed on these isolates also revealed that all had a multi-resistance phenotype, which indicates that the acquired resistance is their major antibiotic resistance mechanism. In conclusion, the two bacterial groups have distinct resistance mechanisms, which suggest that the antibiotic resistance in the environment can be a more complex problematic than that generally assumed. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Wastewater and Its Treatment)

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11 pages, 1198 KiB

Open AccessArticle

New Insight on Antibiotic Resistance and Virulence of Escherichia coli from Municipal and Animal Wastewater

by Gabriela Gregova, Vladimir Kmet and Tatiana Szaboova

Antibiotics 2021, 10(9), 1111; https://doi.org/10.3390/antibiotics10091111 - 14 Sep 2021

Cited by 8 | Viewed by 2424

Abstract

Antibiotic resistance of the indicator microorganism Escherichia coli was investigated in isolates from samples collected during the course of one year from two wastewater treatment plants treating municipal and animal wastes in Slovakia, respectively. The genes of antibiotic resistance and virulence factors in selected resistant E. coli isolates were described. A high percentage of the isolates from municipal and animal wastewater were resistant to ampicillin, streptomycin, tetracycline, ceftiofur, ceftriaxone, and enrofloxacin. In the selected E. coli isolates, we detected the following phenotypes: ESBL (20.4% in animal wastewater; 7.7% in municipal wastewater), multidrug-resistant (17% of animal and 32% of municipal isolates), high resistance to quinolones (25% of animal and 48% of municipal samples), and CTX-M (7.9% of animal and 17.3% of municipal isolates). We confirmed an integro-mediated antibiotic resistance in 13 E. coli strains from municipal and animal wastewater samples, of which the Tn3 gene and virulence genes cvaC, iutA, iss, ibeA, kps, and papC were detected in six isolates. One of the strains of pathogenic E. coli from the animal wastewater contained genes ibeA with papC, iss, kpsII, Int1, Tn3, and Cit. In addition, one bla_IMP gene was found in the municipal wastewater sample. This emphasises the importance of using the appropriate treatment methods to reduce the counts of antibiotic-resistant microorganisms in wastewater effluent. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Wastewater and Its Treatment)

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15 pages, 1198 KiB

Open AccessArticle

Analysis of Wastewater Reveals the Spread of Diverse Extended-Spectrum β-Lactamase-Producing E. coli Strains in uMgungundlovu District, South Africa

by Siyabonga N. Gumede, Akebe L. K. Abia, Daniel G. Amoako and Sabiha Y. Essack

Antibiotics 2021, 10(7), 860; https://doi.org/10.3390/antibiotics10070860 - 15 Jul 2021

Cited by 15 | Viewed by 3225

Abstract

Wastewater treatment plants (WWTPs) are major reservoirs of antibiotic-resistant bacteria (ARB), favouring antibiotic resistance genes (ARGs) interchange among bacteria and they can provide valuable information on ARB circulating in a community. This study characterised extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli from the influent and effluent of four WWTPs in uMgungundlovu District, KwaZulu-Natal, South Africa. E. coli was enumerated using the membrane filtration method and confirmed using the API 20E test and real-time polymerase chain reaction. ESBL-producers were phenotypically identified by their susceptibility to the third-generation cephalosporins using the disc diffusion and the double-disc synergy methods against cefotaxime (30 µg) with and without 10 µg clavulanic acid. Genotypic verification was by PCR of the TEM, SHV, and CTX-M genes. The clonality of isolates was assessed by ERIC-PCR. The highest E. coli count ranged between 1.1 × 10⁵ (influent) and 4.3 × 10³ CFU/mL (effluent). Eighty pure isolates were randomly selected, ten from the influent and effluent of each of the four WWTP. ESBLs were phenotypically confirmed in 49% (n = 39) of the isolates, of which 77% (n = 30) were genotypically confirmed. Seventy-three percent of the total isolates were multidrug-resistant (MDR). Only two isolates were susceptible to all antibiotics. Overall, resistance to first and second-generation cephalosporins was higher than to third and fourth generation cephalosporins. Also, 15% of the isolates were resistant to carbapenems. The CTX-M-type ESBL (67%; n = 20) was the most common ESBL antibiotic resistance gene (ARG) followed by TEM (57%; n = 17) and SHV-types (27%; n = 8). Also, a substantial number of isolates simultaneously carried all three ESBL genes. ERIC-PCR revealed a high diversity of isolates. The diversity of the isolates observed in the influent samples suggest the potential circulation of different ESBL-producing strains within the studied district, requiring a more comprehensive epidemiological study to prevent the spread of ESBL-producing bacteria within impoverished communities. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Wastewater and Its Treatment)

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14 pages, 1436 KiB

Open AccessReview

Degradation of Bacterial Antibiotic Resistance Genes during Exposure to Non-Thermal Atmospheric Pressure Plasma

by Ibtissam Courti, Cristina Muja, Thomas Maho, Florent P. Sainct and Philippe Guillot

Antibiotics 2022, 11(6), 747; https://doi.org/10.3390/antibiotics11060747 - 31 May 2022

Cited by 2 | Viewed by 2440

Abstract

Bacterial resistance to antibiotics has become a major public health problem in recent years. The occurrence of antibiotics in the environment, especially in wastewater treatment plants, has contributed to the development of antibiotic-resistant bacteria (ARB) and the spread of antibiotic resistance genes (ARGs). Despite the potential of some conventional processes used in wastewater treatment plants, the removal of ARB and ARGs remains a challenge that requires further research and development of new technologies to avoid the release of emerging contaminants into aquatic environments. Non-thermal atmospheric pressure plasmas (NTAPPs) have gained a significant amount of interest for wastewater treatment due to their oxidizing potential. They have shown their effectiveness in the inactivation of a wide range of bacteria in several fields. In this review, we discuss the application of NTAPPs for the degradation of antibiotic resistance genes in wastewater treatment. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Wastewater and Its Treatment)

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14 pages, 346 KiB

Open AccessReview

Hospital Wastewater—Source of Specific Micropollutants, Antibiotic-Resistant Microorganisms, Viruses, and Their Elimination

by Tomáš Mackuľak, Klára Cverenkárová, Andrea Vojs Staňová, Miroslav Fehér, Michal Tamáš, Andrea Bútor Škulcová, Miroslav Gál, Monika Naumowicz, Viera Špalková and Lucia Bírošová

Antibiotics 2021, 10(9), 1070; https://doi.org/10.3390/antibiotics10091070 - 4 Sep 2021

Cited by 31 | Viewed by 5151

Abstract

Municipal wastewaters can generally provide real-time information on drug consumption, the incidence of specific diseases, or establish exposure to certain agents and determine some lifestyle consequences. From this point of view, wastewater-based epidemiology represents a modern diagnostic tool for describing the health status of a certain part of the population in a specific region. Hospital wastewater is a complex mixture of pharmaceuticals, illegal drugs, and their metabolites as well as different susceptible and antibiotic-resistant microorganisms, including viruses. Many studies pointed out that wastewater from healthcare facilities (including hospital wastewater), significantly contributes to higher loads of micropollutants, including bacteria and viruses, in municipal wastewater. In addition, such a mixture can increase the selective pressure on bacteria, thus contributing to the development and dissemination of antimicrobial resistance. Because many pharmaceuticals, drugs, and microorganisms can pass through wastewater treatment plants without any significant change in their structure and toxicity and enter surface waters, treatment technologies need to be improved. This short review summarizes the recent knowledge from studies on micropollutants, pathogens, antibiotic-resistant bacteria, and viruses (including SARS-CoV-2) in wastewater from healthcare facilities. It also proposes several possibilities for improving the wastewater treatment process in terms of efficiency as well as economy. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Wastewater and Its Treatment)

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12 pages, 1028 KiB

Open AccessStudy Protocol

Antibiotic Resistance in Wastewater Treatment Plants and Transmission Risks for Employees and Residents: The Concept of the AWARE Study

by Laura Wengenroth, Fanny Berglund, Hetty Blaak, Mariana Carmen Chifiriuc, Carl-Fredrik Flach, Gratiela Gradisteanu Pircalabioru, D. G. Joakim Larsson, Luminita Marutescu, Mark W. J. van Passel, Marcela Popa, Katja Radon, Ana Maria de Roda Husman, Daloha Rodríguez-Molina, Tobias Weinmann, Andreas Wieser and Heike Schmitt

Antibiotics 2021, 10(5), 478; https://doi.org/10.3390/antibiotics10050478 - 21 Apr 2021

Cited by 15 | Viewed by 4330

Abstract

Antibiotic resistance has become a serious global health threat. Wastewater treatment plants may become unintentional collection points for bacteria resistant to antimicrobials. Little is known about the transmission of antibiotic resistance from wastewater treatment plants to humans, most importantly to wastewater treatment plant workers and residents living in the vicinity. We aim to deliver precise information about the methods used in the AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants) study. Within the AWARE study, we gathered data on the prevalence of two antibiotic resistance phenotypes, ESBL-producing E. coli and carbapenemase-producing Enterobacteriaceae, as well as on their corresponding antibiotic resistance genes isolated from air, water, and sewage samples taken from inside and outside of different wastewater treatment plants in Germany, the Netherlands, and Romania. Additionally, we analysed stool samples of wastewater treatment plant workers, nearby residents, and members of a comparison group living ≥1000 m away from the closest WWTP. To our knowledge, this is the first study investigating the potential spread of ESBL-producing E. coli, carbapenemase-producing Enterobacteriaceae, and antibiotic resistance genes from WWTPs to workers, the environment, and nearby residents. Quantifying the contribution of different wastewater treatment processes to the removal efficiency of ESBL-producing E. coli, carbapenemase-producing Enterobacteriaceae, and antibiotic resistance genes will provide us with evidence-based support for possible mitigation strategies. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Wastewater and Its Treatment)

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