Predicting selection for antimicrobial resistance in UK wastewater and aquatic environments: Ciprofloxacin poses a significant risk

A critical meta-analysis of predicted no effect concentrations for antimicrobial resistance selection in the environment

Antimicrobial resistance (AMR) is one of the greatest threats to human health with a growing body of evidence demonstrating that selection for AMR can occur at environmental antimicrobial concentrations. Understanding the concentrations at which selection for resistance may occur is critical to help inform environmental risk assessments and highlight where mitigation strategies are required. A variety of experimental and data approaches have been used to determine these concentrations. However, there is minimal standardisation of existing approaches and no consensus on the relative merits of different methods. We conducted a semi-systematic literature review to collect and critically appraise available minimal selective concentration (MSC) and predicted no effect concentration for resistance (PNECR) data and the approaches used to derive them. There were 21 relevant articles providing 331 selective concentrations, ranging from 0.00087 µg/L (ciprofloxacin) to 2000 µg/L (carbenicillin). Meta-analyses of these data found that selective concentrations are highly compound-dependent, and only a subset of all antimicrobials have been the focus of most of the research. The variety of approaches that have been used, knowledge gaps and future research priorities were identified, as well as recommendations for those considering the selective risks of antimicrobials in the environment.

Selective colonization of microplastics, wood and glass by antimicrobial-resistant and pathogenic bacteria

The Plastisphere is a novel niche whereby microbial communities attach to plastic debris, including microplastics. These communities can be distinct from those found in the surrounding environment or those attached to natural substrates and may serve as a reservoir of both pathogenic and antimicrobial-resistant (AMR) bacteria. Owing to the frequent omission of appropriate comparator particles (e.g. natural substrates) in previous studies, there is a lack of empirical evidence supporting the unique risks posed by microplastics in terms of enrichment and spread of AMR pathogens. This study investigated selective colonization by a sewage community on environmentally sampled microplastics with three different polymers, sources and morphologies, alongside natural substrate (wood), inert substrate (glass) and free-living/planktonic community controls. Culture and molecular methods (quantitative polymerase chain reaction (qPCR)) were used to ascertain phenotypic and genotypic AMR prevalence, respectively, and multiplex colony PCR was used to identify extra-intestinal pathogenic Escherichia coli (ExPECs). From this, polystyrene and wood particles were found to significantly enrich AMR bacteria, whereas sewage-sourced bio-beads significantly enriched ExPECs. Polystyrene and wood were the least smooth particles, and so the importance of particle roughness on AMR prevalence was then directly investigated by comparing the colonization of virgin vs artificially weathered polyethylene particles. Surface weathering did not have a significant effect on the AMR prevalence of colonized particles. Our results suggest that the colonization of plastic and non-plastic particles by AMR and pathogenic bacteria may be enhanced by substrate-specific traits.

Presence of emerging organic contaminants and microbial indicators in surface water and groundwater in urban India

This study presents a first combined assessment of emerging organic contaminants (EOC) and antimicrobial resistance (AMR) indicators in the South Indian city of Bengaluru from multiple sources, addressing a knowledge gap on EOCs and AMR occurrences and relationships in different water sources in urban India. A unique approach in this study was to combine the detection of EOCs with an assessment of the AMR-indicating class 1 integron-integrase gene, intI1. Twenty-five samples collected from groundwater, local surface waters, and tap water imported from the Cauvery Basin were screened for 1499 EOCs. A total of 125 EOCs were detected at concentrations per compound of up to 314 μg/L. Concentrations for a range of contaminants were higher than those previously detected in Indian groundwaters. High concentrations of Per- and polyfluoroalkyl substances (PFAS) were detected with up to 1.8 μg/L in surface water and up to 0.9 μg/L in groundwater. Calculated risk quotients indicated potential AMR development caused by high concentrations of azithromycin, fluconazole, and sulfanilamide in surface waters that have little protection against sewage inflows. Surface waters that have recently undergone environmental restoration (e.g., removing silted bottom layers and enhancing protection against encroachments and sewage inflows) had lower EOC detections and risk of AMR development. Specific EOC detections, e.g., the ubiquitous detection of the sweetener sucralose (in use since ∼2000), indicated recent groundwater recharge and a contribution of imported Cauvery River water for recharge. This study highlights the need for monitoring and water protection, the role of EOCs as potential drivers of AMR, and the success of surface water protection measures to improve freshwater quality.

Nature-based solutions for antibiotics and antimicrobial resistance removal in tertiary wastewater treatment: Microbiological composition and risk assessment

This field-scale study evaluates the seasonal effectiveness of employing nature-based solutions (NBSs), particularly surface flow and horizontal subsurface flow constructed wetland configurations, as tertiary treatment technologies for the removal of antibiotics (ABs) and antibiotic resistance genes (ARGs) compared to a conventional treatment involving UV and chlorination. Out of the 21 monitored ABs, 13 were detected in the influent of three tertiary wastewater treatments, with concentrations ranging from 2 to 1218 ng·L-1. The ARGs sul1 and dfrA1 exhibited concentrations ranging from 1 × 105 to 9 × 106 copies/100 mL. NBSs were better at reducing ABs (average 69 to 88 %) and ARGs (2-3 log units) compared to the conventional tertiary system (average 36 to 39 % and no removal to 2 log units) in both seasons. Taxonomic compositions in influent water samples shifted from wastewater-impacted communities (Actinomycetota and Firmicutes) to a combination of plant rhizosphere-associated and river communities in NBS effluents (Alphaproteobacteria). In contrast, the conventional technology showed no substantial differences in community composition. Moreover, NBSs substantially reduced the ecotoxicological risk assessment (cumulative RQs). Furthermore, NBSs reduced the ecotoxicological risk (cumulative RQs) by an average of over 70 % across seasons, whereas the benchmark technology only achieved a 6 % reduction. In conclusion, NBSs present a robust alternative for minimizing the discharge of ABs and ARGs into surface water bodies.

Do storm overflows influence AMR in the environment and is this relevant to human health? A UK perspective on a global issue

Antimicrobial resistance (AMR) is a global public health threat, and the environment has been identified as an important reservoir for resistant microorganisms and genes. Storm overflows (SOs) discharge wastewater and stormwater, and are found throughout many wastewater networks. While there are no data currently showing the impact of SOs on the environment with respect to AMR in the UK, there is a small but growing body of evidence globally highlighting the potential role of SOs on environmental AMR. This review aims to provide an overview of the current state of SOs, describe global data investigating the impact of SOs on environmental AMR, and discuss the implications of SOs regarding AMR and human health. In addition, the complexities of studying the effects of SOs are discussed and a set of priority research questions and policy interventions to tackle a potentially emerging threat to public health are presented.

Environment, animals, and food as reservoirs of antibiotic-resistant bacteria for humans: One health or more?

Antimicrobial resistance (AMR) is a major public health challenge. For several years, AMR has been addressed through a One Health approach that links human health, animal health, and environmental quality. In this review, we discuss AMR in different reservoirs with a focus on the environment. Anthropogenic activities produce effluents (sewage, manure, and industrial wastes) that contaminate soils and aquatic environments with antibiotic-resistant bacteria (ARB), antibiotic-resistant genes (ARGs), and selective agents such as antibiotics, biocides, and heavy metals. Livestock treated with antibiotics can also contaminate food with ARB. In high-income countries (HICs), effective sanitation infrastructure and limited pharmaceutical industries result in more controlled discharges associated with human activities. Hence, studies using genome-based typing methods have revealed that, although rare inter-reservoir transmission events have been reported, human acquisition in HICs occurs primarily through person-to-person transmission. The situation is different in low- and middle-income countries (LMICs) where high population density, poorer sanitation and animal farming practices are more conducive to inter-reservoir transmissions. In addition, environmental bacteria can be a source of ARGs that, when transferred to pathogenic species under antibiotic selection pressure in environmental hotspots, produce new antibiotic-resistant strains that can potentially spread in the human community through human-to-human transmission. The keys to reducing AMR in the environment are (i) better treatment of human waste by improving wastewater treatment plants (WWTPs) in HICs and improving sanitation infrastructure in LMICs, (ii) reducing the use of antibiotics by humans and animals, (iii) prioritizing the use of less environmentally harmful antibiotics, and (iv) better control of pharmaceutical industry waste.

Future prediction of biogas potential and CH4 emission with boosting algorithms: the case of cattle, small ruminant, and poultry manure from Turkey

Animal waste can be converted into a renewable energy source using biogas technology. This process has an impact on greenhouse gas emissions and is a sustainable source of energy for countries. It can reduce the effects of climate change and protect the planet for future generations. Tier1 and tier2 approaches are commonly used in the literature to calculate emissions factors. With boosting algorithms, this study estimated each animal category's biogas potential and CH4 emissions (tier1 and tier2 approach) for 2004-2021 in all of Turkey's provinces. Two different scenarios were created in the study. For scenario-1, the years 2020-2021 were predicted using data from 2004 to 2019, while for scenario-2, the years 2022-2024 were predicted using data from 2004 to 2021. According to the scenario-1 analysis, the eXtreme Gradient Boosting Regressor (XGBR) algorithm was the most successful algorithm with an R2 of 0.9883 for animal-based biogas prediction and 0.9835 and 0.9773 for animal-based CH4 emission predictions (tier1 and tier2 approaches) for the years 2020-2021. When the mean absolute percentage error was evaluated, it was found to be relatively low at 0.46%, 1.07%, and 2.78%, respectively. According to the scenario-2 analysis, the XGBR algorithm predicted the log10 values of the animal-based biogas potential of five major cities in Turkey for the year 2024, with 11.279 for Istanbul, 12.055 for Ankara, 12.309 for Izmir, 11.869 for Bursa, and 12.866 for Antalya. In the estimation of log10 values of CH4 emission, the tier1 approach yielded estimates of 3.080, 3.652, 3.929, 3.411, and 3.321, respectively, while the tier2 approach yielded estimates of 1.810, 2.806, 2.757, 2.552 and 2.122, respectively.

Development of an in vitro biofilm model for the study of the impact of fluoroquinolones on sewer biofilm microbiota

Sewer biofilms are likely to constitute hotspots for selecting and accumulating antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs). This study aimed to optimize culture conditions to obtain in vitro biofilms, mimicking the biofilm collected in sewers, to study the impact of fluoroquinolones (FQs) on sewer biofilm microbiota. Biofilms were grown on coupons in CDC Biofilm Reactors®, continuously fed with nutrients and inoculum (1/100 diluted wastewater). Different culture conditions were tested: (i) initial inoculum: diluted wastewater with or without sewer biofilm, (ii) coupon material: concrete vs. polycarbonate, and (iii) time of culture: 7 versus 14 days. This study found that the biomass was highest when in vitro biofilms were formed on concrete coupons. The biofilm taxonomic diversity was not affected by adding sewer biofilm to the initial inoculum nor by the coupon material. Pseudomonadales, Burkholderiales and Enterobacterales dominated in the sewer biofilm composition, whereas in vitro biofilms were mainly composed of Enterobacterales. The relative abundance of qnrA, B, D and S genes was higher in in vitro biofilms than sewer biofilm. The resistome of sewer biofilm showed the highest Shannon diversity index compared to wastewater and in vitro biofilms. A PCoA analysis showed differentiation of samples according to the nature of the sample, and a Procrustes analysis showed that the ARG changes observed were linked to changes in the microbial community. The following growing conditions were selected for in vitro biofilms: concrete coupons, initial inoculation with sewer biofilm, and a culture duration of 14 days. Then, biofilms were established under high and low concentrations of FQs to validate our in vitro biofilm model. Fluoroquinolone exposure had no significant impact on the abundance of qnr genes, but high concentration exposure increased the proportion of mutations in gyrA (codons S83L and D87N) and parC (codon S80I). In conclusion, this study allowed the determination of the culture conditions to develop an in vitro model of sewer biofilm; and was successfully used to investigate the impact of FQs on sewer microbiota. In the future, this setup could be used to clarify the role of sewer biofilms in disseminating resistance to FQs in the environment.

Degradation and transformation of carbamazepine in aqueous medium under non-thermal plasma oxidation process

Carbamazepine (CBZ) is a pharmaceutical compound detected in various water resources. With a view to removing this contaminant, the applicability of non-thermal plasma (NTP) oxidation process has been widely tested in recent years. This study utilized NTP from a dielectric barrier discharge reactor in the treatment of CBZ. NTP on the surface of a water sample containing 25 mg.L-1 of CBZ resulted in a removal efficiency of over 90% with an energy yield of 0.19 g. (kWh)-1. On the other hand, a rapid reduction in pH and an increase of conductivity and nitrate/nitrite ions concentration were observed during the degradation. The applied voltage amplitude significantly affected the removal efficiency and the energy yield as the degradation efficiency was 55%, 70%, and 72% respectively with an applied voltage of 8, 10, and 12 kV. The water matrices containing inorganic anions such as chloride and carbonate ions reduced the removal efficiency by scavenging the reactive species. Accordingly, a reduction in the removal efficiency was observed in tap water. The high-resolution mass spectrometry (HRMS) results revealed that both reactive oxygen and nitrogen species take part in the reaction process which yields many intermediate products including aromatic nitro-products. This study concluded that NTP can effectively degrade CBZ in both pure and tap water, but special attention must be paid to changes in the water quality parameters (pH, conductivity, and nitrate/nitrite ions) and the fate of nitro products.

A review of the degradation of antibiotic contaminants using advanced oxidation processes: modification and application of layered double hydroxides based materials

In recent years, the treatment of organic pollutants has become a global concern due to the threat to human health posed by emerging contaminants, especially antibiotic contamination. Advanced oxidation processes (AOPs) can solve the organic pollution problem well, which have been identified as a promising solution for the treatment of hard-to-handle organic compounds including antibiotic contaminants. Layered double hydroxides (LDHs) are excellent catalysts because of their flexible tunability, favorable thermal stability, abundant active sites, and facile exchangeability of intercalated anions. This paper conducted a systematic review of LDHs-based materials used for common antibiotic removal by three significant AOP technologies, such as photocatalysis, the Fenton-like processes, and peroxymonosulfate catalysis. The degradation effects studied in various studies were reviewed, and the mechanisms were discussed in detail based on the type of AOPs. Finally, the challenges and the application trends of AOPs that may arise were prospected. The aim of this study is to suggest ways to provide practical guidance for the screening and improvement of LDH materials and the rational selection of AOPs to achieve efficient antibiotic degradation. This could lead to the development of more efficient and environmentally friendly materials and processes for degrading antibiotics, with significant implications for our ecological conservation by addressing water pollution.

Alternations of antibiotic resistance genes and microbial community dynamics on shared bicycles before and after pandemic lockdown

The prevalence of shared bicycles has raised concerns over their potential to transmit pathogens and microbes harboring antibiotic resistance genes (ARGs), which pose significant human health risks. This study investigated the impact of anthropogenic activities on the composition of ARGs and microbial communities on shared bicycles during the COVID-19 pandemic and subsequent lockdown when shared bicycle usage was altered. A total of 600 swab samples from shared bicycle surfaces were collected in Shanghai before and during COVID-19 lockdown periods. Even during lockdown, 12 out of 14 initially detected ARG subtypes persisted, indicating their tenacity in the face of reduced anthropogenic activities. These ARGs displayed significantly higher absolute and relative abundance levels before the lockdown. In addition, the percentage of potential pathogens in the total microbial abundance remained at 0.029 % during the lockdown, which was lower than the pre-lockdown percentage of 0.035 % and suggested that these risks persist within shared bicycle systems. Interestingly, although microbial abundance decreased without the consecutive use of shared bicycles during lockdown, the microbial diversity increased under the impact of restricted anthropogenic activities (p < 0.001). This emphasizes the need for continuous monitoring and research to comprehend microbial community behaviors in various environments. This study uncovered the underlying impacts of the COVID-19 lockdown on the microbial and ARG communities of shared bicycles, providing comprehensive insights into the health management of shared transportation. Although lockdown can decrease the abundance of ARGs and potential pathogens, additional interventions are needed to prevent their continued spread.

Selection for antimicrobial resistance in the plastisphere

Microplastics and antimicrobials are widespread contaminants that threaten global systems and frequently co-exist in the presence of human or animal pathogens. Whilst the impact of each of these contaminants has been studied in isolation, the influence of this co-occurrence in driving antimicrobial resistance (AMR)1 in microplastic-adhered microbial communities, known as 'the Plastisphere', is not well understood. This review proposes the mechanisms by which interactions between antimicrobials and microplastics may drive selection for AMR in the Plastisphere. These include: 1) increased rates of horizontal gene transfer in the Plastisphere compared with free-living counterparts and natural substrate controls due to the proximity of cells, co-occurrence of environmental microplastics with AMR selective compounds and the sequestering of extracellular antibiotic resistance genes in the biofilm matrix. 2) An elevated AMR selection pressure in the Plastisphere due to the adsorbing of AMR selective or co-selective compounds to microplastics at concentrations greater than those found in surrounding mediums and potentially those adsorbed to comparator particles. 3) AMR selection pressure may be further elevated in the Plastisphere due to the incorporation of antimicrobial or AMR co-selective chemicals in the plastic matrix during manufacture. Implications for both ecological functioning and environmental risk assessments are discussed, alongside recommendations for further research.

Hospital and urban wastewaters shape the matrix and active resistome of environmental biofilms

Understanding the dynamics of antibiotic resistance gene (ARG) transfer and dissemination in natural environments remains challenging. Biofilms play a crucial role in bacterial survival and antimicrobial resistance (AMR) dissemination in natural environments, particularly in aquatic systems. This study focused on hospital and urban wastewater (WW) biofilms to investigate the potential for ARG dissemination through mobile genetic elements (MGEs). The analysis included assessing the biofilm extracellular polymeric substances (EPS), microbiota composition as well as metatranscriptomic profiling of the resistome and mobilome. We produced both in vitro and in situ biofilms and performed phenotypic and genomic analyses. In the in vitro setup, untreated urban and hospital WW was used to establish biofilm reactors, with ciprofloxacin added as a selective agent at minimal selective concentration. In the in situ setup, biofilms were developed directly in hospital and urban WW pipes. We first showed that a) the composition of EPS differed depending on the growth environment (in situ and in vitro) and the sampling origin (hospital vs urban WW) and that b) ciprofloxacin impacted the composition of the EPS. The metatranscriptomic approach showed that a) expression of several ARGs and MGEs increased upon adding ciprofloxacin for biofilms from hospital WW only and b) that the abundance and type of plasmids that carried individual or multiple ARGs varied depending on the WW origins of the biofilms. When the same plasmids were present in both, urban and hospital WW biofilms, they carried different ARGs.  We showed that hospital and urban wastewaters shaped the structure and active resistome of environmental biofilms, and we confirmed that hospital WW is an important hot spot for the dissemination and selection of antimicrobial resistance. Our study provides a comprehensive assessment of WW biofilms as crucial hotspots for ARG transfer. Hospital WW biofilms exhibited distinct characteristics, including higher eDNA abundance and expression levels of ARGs and MGEs, highlighting their role in antimicrobial resistance dissemination. These findings emphasize the importance of understanding the structural, ecological, functional, and genetic organization of biofilms in anthropized environments and their contribution to antibiotic resistance dynamics.

New insights into the antimicrobial action and protective therapeutic effect of tirapazamine towards Escherichia coli-infected mice

OBJECTIVES

Escherichia coli is an important pathogen responsible for numerous cases of diarrhoea worldwide. The bioreductive agent tirapazamine (TPZ), which was clinically used to treat various types of cancers, has obvious antibacterial activity against E. coli strains. In the present study, we aimed to evaluate the protective therapeutic effects of TPZ in E. coli-infected mice and provide insights into its antimicrobial action mechanism.

METHODS

The MIC and MBC tests, drug sensitivity test, crystal violet assay and proteomic analysis were used to detect the in vitro antibacterial activity of TPZ. The clinical symptoms of infected mice, tissue bacteria load, histopathological features and gut microbiota changes were regarded as indicators to evaluation the efficacy of TPZ in vivo.

RESULTS

Interestingly, TPZ-induced the reversal of drug resistance in E. coli by regulating the expression of resistance-related genes, which may have an auxiliary role in the clinical treatment of drug-resistant bacterial infections. More importantly, the proteomics analysis showed that TPZ upregulated 53 proteins and downregulated 47 proteins in E. coli. Among these, the bacterial defence response-related proteins colicin M and colicin B, SOS response-related proteins RecA, UvrABC system protein A, and Holliday junction ATP-dependent DNA helicase RuvB were all significantly upregulated. The quorum sensing-related protein glutamate decarboxylase, ABC transporter-related protein glycerol-3-phosphate transporter polar-binding protein, and ABC transporter polar-binding protein YtfQ were significantly downregulated. The oxidoreductase activity-related proteins pyridine nucleotide-disulfide oxidoreductase, glutaredoxin 2 (Grx2), NAD(+)-dependent aldehyde reductase, and acetaldehyde dehydrogenase, which participate in the elimination of harmful oxygen free radicals in the oxidation-reduction process pathway, were also significantly downregulated. Moreover, TPZ improved the survival rate of infected mice; significantly reduced the bacteria load in the liver, spleen, and colon; and alleviated E. coli-associated pathological damages. The gut microbiota also changed in TPZ-treated mice, and these genera were considerably differentiated: Candidatus Arthromitus, Eubacterium coprostanoligenes group, Prevotellaceae UCG-001, Actinospica, and Bifidobacterium.

CONCLUSIONS

TPZ may represent an effective and promising lead molecule for the development of antimicrobial agents for the treatment of E. coli infections.

Enhanced Catalytic Ozonation by Mn-Ce Oxide-Loaded Al2O3 Catalyst for Ciprofloxacin Degradation

Catalytic ozonation is an effective and promising advanced oxidation technology for organic pollutant removal. Herein, CexMn_1-xO₂ metal oxides loaded on Al₂O₃ catalysts (Mn-Ce/Al₂O₃) were synthesized for catalytic ozonation of the wastewater containing ciprofloxacin. The morphology, crystal structure, and specific surface area of the prepared catalyst were characterized. The characteristics of the Mn-Ce/Al₂O₃ catalyst revealed that the loaded MnO₂ could interfere with the formed CeO₂ crystals and then produced complex CexMn_1-xO₂ oxides. Compared with an ozone-alone system (47.4%), the ciprofloxacin degradation efficiency in the Mn-Ce/Al₂O₃ catalytic ozonation system elevated to 85.1% within 60 min. The ciprofloxacin degradation kinetic rate over the Mn-Ce/Al₂O₃ catalyst is 3.0 times that of the ozone-alone system. The synergetic corporation of redox pairs between Mn(III)/Mn(IV) and Ce(III)/Ce(IV) in the Mn-Ce/Al₂O₃ catalyst could accelerate ozone decomposition to generate active oxygen species and further significantly improve the mineralization efficiency of ciprofloxacin. The work demonstrates the great potential of developing dual-site ozone catalysts for advanced treatment of wastewater.

A novel equal frequency sampling of factor levels (EFSFL) method is applied to identify the dominant factor inducing the combined toxicities of 13 factors

The research framework combining global sensitivity analysis (GSA) with quantitative high-throughput screening (qHTS), called GSA-qHTS, provides a potentially feasible way to screen for important factors that induce toxicities of complex mixtures. Despite its value, the mixture samples designed using the GSA-qHTS technique still have a shortage of unequal factor levels, which leads to an asymmetry in the importance of elementary effects (EEs). In this study, we developed a novel method for mixture design that enables equal frequency sampling of factor levels (called EFSFL) by optimizing both the trajectory number and the design and expansion of the starting points for the trajectory. The EFSFL has been successfully employed to design 168 mixtures of 13 factors (12 chemicals and time) that each have three levels. By means of high-throughput microplate toxicity analysis, the toxicity change rules of the mixtures are revealed. Based on EE analysis, the important factors affecting the toxicities of the mixtures are screened. It was found that erythromycin is the dominant factor and time is an important non-chemical factor in mixture toxicities. The mixtures can be classified into types A, B, and C mixtures according to their toxicities at 12 h, and all the types B and C mixtures contain erythromycin at the maximum concentration. The toxicities of the type B mixtures increase firstly over time (0.25 ∼ 9 h) and then decrease (12 h), while those of the type C mixtures consistently increase over time. Some type A mixtures produce stimulation that increases with time. With the present new approach to mixture design, the frequency of factor levels in mixture samples is equal. Consequently, the accuracy of screening important factors is improved based on the EE method, providing a new method for the study of mixture toxicity.