A review on disinfection technologies for controlling the antibiotic resistance spread

Nanomaterial-Enhanced Hybrid Disinfection: A Solution to Combat Multidrug-Resistant Bacteria and Antibiotic Resistance Genes in Wastewater

This review explores the potential of nanomaterial-enhanced hybrid disinfection methods as effective strategies for addressing the growing challenge of multidrug-resistant (MDR) bacteria and antibiotic resistance genes (ARGs) in wastewater treatment. By integrating hybrid nanocomposites and nanomaterials, natural biocides such as terpenes, and ultrasonication, this approach significantly enhances disinfection efficiency compared to conventional methods. The review highlights the mechanisms through which hybrid nanocomposites and nanomaterials generate reactive oxygen species (ROS) under blue LED irradiation, effectively disrupting MDR bacteria while improving the efficacy of natural biocides through synergistic interactions. Additionally, the review examines critical operational parameters-such as light intensity, catalyst dosage, and ultrasonication power-that optimize treatment outcomes and ensure the reusability of hybrid nanocomposites and other nanomaterials without significant loss of photocatalytic activity. Furthermore, this hybrid method shows promise in degrading ARGs, thereby addressing both microbial and genetic pollution. Overall, this review underscores the need for innovative wastewater treatment solutions that are efficient, sustainable, and scalable, contributing to the global fight against antimicrobial resistance.

Natural pyrite and ascorbic acid co-enhance periodate activation for inactivation of antibiotic resistant bacteria and inhibition of resistance genes transmission: A green disinfection process dominated by singlet oxygen

The transmission of antibiotic resistance genes (ARGs) and the propagation of antibiotic resistant bacteria (ARB) threaten public health security and human health, and greener and more efficient disinfection technologies are expected to be discovered for wastewater treatment. In this study, natural pyrite and ascorbic acid (AA) were proposed as environmental-friendly activator and reductant for periodate (PI) activation to inactivate ARB. The disinfection treatment of PI/pyrite/AA system could inactivate 5.62 log ARB within 30 min, and the lower pH and higher PI and natural pyrite dosage could further boost the disinfection efficiency. The 1O2 and SO4•- were demonstrated to be crucial for the inactivation of ARB in PI/pyrite/AA system. The disinfection process destroyed the morphological structure of ARB, inducing oxidative stress and stimulating the antioxidant system. The PI/pyrite/AA system effectively reduced the intracellular and extracellular DNA concentration and ARGs abundance, inhibiting the propagation of ARGs. The presence of AA facilitated the activation of PI with natural pyrite and significantly increased the concentration of Fe2+ in solution. The reusability of natural pyrite, the safety of the disinfection by-products and the inhibition of ARB regeneration indicated the application potential of PI/pyrite/AA system in wastewater disinfection.

Dynamics of antimicrobial resistance and susceptibility profile in full-scale hospital wastewater treatment plants

Drug resistance has become a matter of great concern, with many bacteria now resist multiple antibiotics. This study depicts the occurrence of antibiotic-resistant bacteria (ARB) and resistance patterns in five full-scale hospital wastewater treatment plants (WWTPs). Samples of raw influent wastewater, as well as pre- and post-disinfected effluents, were monitored for targeted ARB and resistance genes in September 2022 and February 2023. Shifts in resistance profiles of Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii antimicrobial-resistant indicators in the treated effluent compared to that in the raw wastewater were also worked out. Ceftazidime (6.78 × 105 CFU/mL) and cefotaxime (6.14 × 105 CFU/mL) resistant species showed the highest concentrations followed by ciprofloxacin (6.29 × 104 CFU/mL), and gentamicin (4.88 × 104 CFU/mL), in raw influent respectively. WWTP-D employing a combination of biological treatment and coagulation/clarification for wastewater decontamination showed promising results for reducing ARB emissions from wastewater. Relationships between treated effluent quality parameters and ARB loadings showed that high BOD5 and nitrate levels were possibly contributing to the persistence and/or selection of ARBs in WWTPs. Furthermore, antimicrobial susceptibility tests of targeted species revealed dynamic shifts in resistance profiles through treatment processes, highlighting the potential for ARB and ARGs in hospital wastewater to persist or amplify during treatment.

Advances on electrochemical disinfection research: Mechanisms, influencing factors and applications

Disinfection, a vital barrier against pathogenic microorganisms, is crucial in halting the spread of waterborne diseases. Electrochemical methods have been extensively researched and implemented for the inactivation of pathogenic microorganisms from water and wastewater, primarily owing to their simplicity, efficiency, and eco-friendliness. This review succinctly outlined the core mechanisms of electrochemical disinfection (ED) and systematically examined the factors influencing its efficacy, including anode materials, system conditions, and target species. Additionally, the practical application of ED in water and wastewater treatment was comprehensively reviewed. Case studies involving various scenarios such as drinking water, hospital wastewater, black water, rainwater, and ballast water provided concrete instances of the expansive utility of ED. Finally, coupling ED with other technologies and the resulting synergies were introduced as pivotal foundations for subsequent engineering advancements.

Sterilization mechanism and nanotoxicity of visible light-driven defective carbon nitride and UV-excited TiO2

The sterilization effect of photocatalysis and biotoxicity of nanomaterial catalysts have attracted high attention. In this study, the novel visible-driven defective carbon nitride (VL/DCN) system exhibits non-photoreactivation, non-toxic superior performance compared with traditional ultraviolet radiation (UV) and UV/titanium dioxide (UV/TiO2). The inactivation of antibiotic-resistant bacteria (ARB) by novel VL/DCN still reached 7 log within 4 h, and the reduction rates of aminoglycoside gene strB and tetracycline gene tetA exceeded 0.8 log and 1.2 log, respectively. Further, the sterilization mechanism and nanotoxicity were contrastively and systematically analyzed among above three systems as following. Firstly, in the VL/DCN system, reactive oxygen species (ROSs) generated from photocatalytic process leads to the destruction of cell membranes, resulting in dissolving out of potassium ion (K+), protein and cell membrane ATP content. Thus, resistant bacteria were completely inactivated and photoreactivation disappears. In contrast, the UV only acted on bacterial DNA and existed the light resurrection. The UV/TiO2 strictly dependent on ultraviolet light and can be used in limited scenarios. Secondly, in cell viability analysis by human lung cell line BEAS-2B experiments, the 10% inhibition of cell growth when DCN was 600 mg/L much lower than 28% inhibition of cell growth when TiO2 was only 200 mg/L. The expression of pro-inflammatory cytokines ((Interleukin, IL) -6), IL-8, IL-1β) under the effect of DCN was 1.5-fold, 5.7-fold and 3.7-fold lower than TiO2, respectively. Meanwhile, DCN induced cells to produce less ROSs, malondialdehyde (MDA), and more superoxide dismutase (SOD). Above results demonstrated that DCN has far lower cytotoxicity than TiO2. This study provides theoretical support for the application of photocatalytic sterilization technology and the exploration of the toxicity of nanomaterials.

Recent developments on advanced oxidation processes for degradation of pollutants from wastewater with focus on antibiotics and organic dyes

The existence of various pollutants in water environment contributes to global pollution and poses significant threats to humans, wildlife, and other living beings. The emergence of an effective, realistic, cost-effective, and environmentally acceptable technique to treat wastewater generated from different sectors is critical for reducing pollutant accumulation in the environment. The electrochemical advanced oxidation method is a productive technology for treating hazardous effluents because of its potential benefits such as lack of secondary pollutant and high oxidation efficiency. Recent researches on advanced oxidation processes (AOPs) in the period of 2018-2022 are highlighted in this paper. This review emphasizes on recent advances in electro-oxidation (EO), ozone oxidation, sonolysis, radiation, electro-Fenton (EF), photolysis and photocatalysis targeted at treating pharmaceuticals, dyes and pesticides polluted effluents. In the first half of the review, the concept of the AOPs are discussed briefly. Later, the influence of increasing current density, pH, electrode, electrolyte and initial concentration of effluents on degradation are discussed. Lastly, previously reported designs of electrochemical reactors, as well as data on intermediates generated and energy consumption during the electro oxidation and Fenton processes are discussed. According to the literature study, the electro-oxidation technique is more appropriate for organic compounds, whilst the electro-Fenton technique appear to be more appropriate for more complex molecules.

Inactivation of antibiotic-resistant bacteria in hospital wastewater by ozone-based advanced water treatment processes

The emergence and spread of antimicrobial resistance (AMR) continue on a global scale. The impacts of wastewater on the environment and human health have been identified, and understanding the environmental impacts of hospital wastewater and exploring appropriate forms of treatment are major societal challenges. In the present research, we evaluated the efficacy of ozone (O3)-based advanced wastewater treatment systems (O3, O3/H2O2, O3/UV, and O3/UV/H2O2) for the treatment of antimicrobials, antimicrobial-resistant bacteria (AMRB), and antimicrobial resistance genes (AMRGs) in wastewater from medical facilities. Our results indicated that the O3-based advanced wastewater treatment inactivated multiple antimicrobials (>99.9%) and AMRB after 10-30 min of treatment. Additionally, AMRGs were effectively removed (1.4-6.6 log10) during hospital wastewater treatment. The inactivation and/or removal performances of these pollutants through the O3/UV and O3/UV/H2O2 treatments were significantly (P < 0.05) better than those in the O3 and O3/H2O2 treatments. Altered taxonomic diversity of microorganisms based on 16S rRNA gene sequencing following the O3-based treatment showed that advanced wastewater treatments not only removed viable bacteria but also removed genes constituting microorganisms in the wastewater. Consequently, the objective of this study was to apply advanced wastewater treatments to treat wastewater, mitigate environmental pollution, and alleviate potential threats to environmental and human health associated with AMR. Our findings will contribute to enhancing the effectiveness of advanced wastewater treatment systems through on-site application, not only in wastewater treatment plants (WWTPs) but also in medical facilities. Moreover, our results will help reduce the discharge of AMRB and AMRGs into rivers and maintain the safety of aquatic environments.

Application of electrochemical oxidation for the enhancement of antibiotic resistant bacteria removal in stormwater bioretention cells

Recently, increasing attention has been paid to the removal of antibiotic resistant bacteria (ARB) during electrochemical advanced oxidation processes. However, there is still no available literature about the application of electrochemical oxidation (EO) to enhance ARB removal in stormwater bioretention cells. Batch experiments were conducted to investigate target ARB (E. coli K-12 carrying blaTEM, tetR and aphA) removals in bioretention cells with different current densities and ratios of air to water (A/W). ARB removals for bioretention cells with 17.6 μA/m² of current density and 24:1 of A/W ratio was the largest with 5.28 log reduction, which was obviously higher than the one (3.68 log reduction) in the control (without EO). H₂O₂ production could be responsible for ARB removals in the used bioretention cells, where H₂O₂ levels increased at first and then decreased with the increase of current densities and A/W ratios. The evaluation for the application of EO implied that the highest antibiotic resistance (AR) conjugation frequency (3.8 × 10^-3) at 3.5 μA/m² of current density and 48:1 of A/W ratios was 124.5 % of the one in the control, while the largest AR transformation frequencies at 17.6 μA/m² of current density and 48:1 of A/W ratios was 366.9 % (tetR) and 216.2 % (aphA) of the corresponding in the control, and there were still stable for both dominant microflora and metabolic activities in bioretention cells with electricity and aeration, suggesting that EO could be promising for the enhancement of ARB removals in bioretention cells.

Review of hospital effluents: special emphasis on characterization, impact, and treatment of pollutants and antibiotic resistance

Health care institutions generate large volumes of liquid effluents from specific activities related to healthcare, analysis, and research. Their direct discharge into the environment has various negative effects on aquatic environments and human health, due to their high organic matter charges and the presence of various emerging contaminants such as disinfectants, drugs, bacteria, viruses, and parasites. Moreover, hospital effluents, by carrying antibiotics, contribute to the development of antibiotic-resistant microorganisms in the environment. This resistance has become a global issue that manifests itself variously in different countries, causing the transmission of different infections. In this respect, an effort is provided to protect water resources by current treatment methods that imply physical-chemical processes such as adsorption and advanced oxidation processes, biological processes such as activated sludge and membrane bioreactors and other hybrid techniques. The purpose of this review is to improve the knowledge on the composition and impact of hospital wastewater on man and the environment, highlighting the different treatment techniques appropriate to this type of disposal before discharge into the environment.

Electrochemical disinfection may increase the spread of antibiotic resistance genes by promoting conjugal plasmid transfer

Current in the milliampere range can be used for electrochemical inactivation of bacteria. Yet, bacteria-including antibiotic resistant bacteria (ARB) may be subjected to sublethal conditions due to imperfect mixing or energy savings measures during electrochemical disinfection. It is not known whether such sublethal current intensities have the potential to stimulate plasmid transfer from ARB. In this study, conjugal transfer of plasmid pKJK5 was investigated between Pseudomonas putida strains under conditions reflecting electrochemical disinfection. Although the abundance of culturable and membrane-intact donor and recipient cells decreased with applied current (0-60 mA), both transconjugant density and transconjugant frequency increased. Both active chlorine and superoxide radicals were generated electrolytically, and ROS generation was induced. In addition, we detected significant over expression of a core oxidative stress defense gene (ahpCF) with current. Expression of selected conjugation related genes (traE, traI, trbJ, and trbL) also significantly correlated with current intensity. ROS accumulation, SOS response and subsequent derepression of conjugation are therefore the plausible consequence of sublethal current exposure. These findings suggest that sublethal intensities of current can enhance conjugal plasmid transfer, and that it is essential that conditions of electrochemical disinfection (applied voltage, current density, time and mixing) are carefully controlled to avoid conjugal ARG transmission.

Degradation of antibiotics by electrochemical advanced oxidation processes (EAOPs): Performance, mechanisms, and perspectives

Global consumption and discharge of antibiotics have led to the rapid development and spread of bacterial antibiotic resistance. Among treatment strategies, electrochemical advanced oxidation processes (EAOPs) are gaining popularity for treating water/wastewater containing antibiotics due to their high efficiency and easiness of operation. In this review, we summarize various forms of EAOPs that contribute to antibiotic degradation, including common electrochemical oxidation (EO), electrolyte enhanced EO, electro-Fenton (EF) processes, EF-like process, and EAOPs coupling with other processes. Then we assess the performance of various EAOPs in antibiotic degradation and discuss the influence of key factors, including electrode, initial concentration and type of antibiotic, operation conditions, electrolyte, and water quality. We also review mechanisms and degradation pathways of various antibiotics degradation by EAOPs, and address the species and toxicity of intermediates produced during antibiotics treatment. Finally, we highlight challenges and critical research needs to facilitate the application of EAOPs in antibiotic treatment.

Research progress of electrochemical oxidation and self-action of electric field for medical wastewater treatment

A large number of pathogenic microorganisms exist in medical wastewater, which could invade the human body through the water and cause harm to human health. With the global pandemic coronavirus (COVID-19), public health safety become particularly important, and medical wastewater treatment is an important part of it. In particular, electrochemical disinfection technology has been widely studied in medical wastewater treatment due to its greenness, high efficiency, convenient operation, and other advantages. In this paper, the development status of electrochemical disinfection technology in the treatment of medical wastewater is reviewed, and an electrochemical three-stage disinfection system is proposed for the treatment of medical wastewater. Moreover, prospects for the electrochemical treatment of medical wastewater will be presented. It is hoped that this review could provide insight and guidance for the research and application of electrochemical disinfection technology to treat medical wastewater.GRAPHICAL ABSTRACT.

Inactivation of a pathogenic NDM-1-positive Escherichia coli strain and the resistance gene blaNDM-1 by TiO2/UVA photocatalysis

Proliferation of bla_NDM-1 in water and wastewater is particularly concerning because of multidrug-resistance and horizontal transfer of the gene. In the present study, a pathogenic NDM-1-positive Escherichia coli strain (named E. coli NDM-1) and the bla_NDM-1 gene were treated with titanium dioxide (TiO₂)/ultraviolet A (UVA) photocatalysis. Effects of catalyst dose, UVA intensity, and phosphate on bacteria and intracellular and extracellular bla_NDM-1 genes were determined. With increases in TiO₂ dose and UVA intensity, the inactivation rate of E. coli NDM-1 increased greatly in saline solution. However, phosphate in water hindered adsorption of bacteria to TiO₂ and partly changed the TiO₂ photocatalytic pathway, resulting in low degradation efficiency. Although inactivation of E. coli NDM-1 was highly efficient, TiO₂/UVA photocatalysis had little effect on removal of the bla_NDM-1 gene. During the 2-h photocatalytic experiments, E. coli cells decreased by 4.7-log, while the bla_NDM-1 gene decreased by 0.7- ~ 1.5-log. Moreover, the degradation rate of extracellular bla_NDM-1 was ~2.7 times higher than that of intracellular genes. Abundance and transformation frequency of residual bla_NDM-1 genes remained high, even when bacteria were completely inactivated, indicating potential health risks. Increases in treatment time and UVA irradiation intensity are needed to remove the bla_NDM-1 gene to sufficiently low levels.

Antibiotic resistant bacteria inactivation through metal-free electrochemical disinfection with carbon catalysts and its potential risks

Recently, increasing attention has been paid to the inactivation of antibiotic resistant bacteria (ARB) during the electrochemical disinfection. However, no available information could be found on ARB inactivation in water during metal-free electrochemical disinfection. In this study, polyvinylidene fluoride (PVDF)-based carbon catalyst (PPC) was chosen as working electrode. Batch experiments were conducted to investigate key design for ARB inactivation, effects of water matrix and potential risks after the disinfection under the pre-determined conditions. The disinfection with current density at 2.25 mA/cm² and Air/Water ratio of 10:1 was optimal with the largest ARB inactivation (5.0 log reduction for 40 min), which was in line with the profile and yield of hydrogen peroxide (H₂O₂) during the disinfection. Effects of water matrix analysis implied that ARB inactivation efficiencies during the disinfection in acidic solutions were better than the one in alkaline solutions, which could be due to rich CC levels on surface of PPC cathode. After the optimal disinfection, ARB counts increased slightly at the first 2 h and then tended to disappear, and there were no conjugation transfer and little transformation for target antibiotic resistance genes, indicating that potential risks could be blocked after the disinfection for 40 min. Furthermore, intermittent flow was more effective in inactivating ARB compared with continuous flow. These suggested that the application of metal-free electrochemical disinfection with PPC to inactivate ARB in water was feasible and desirable in this study.

Review of Antimicrobial Resistance in Wastewater in Japan: Current Challenges and Future Perspectives

Antimicrobial resistance (AMR) circulates through humans, animals, and the environments, requiring a One Health approach. Recently, urban sewage has increasingly been suggested as a hotspot for AMR even in high-income countries (HICs), where the water sanitation and hygiene infrastructure are well-developed. To understand the current status of AMR in wastewater in a HIC, we reviewed the epidemiological studies on AMR in the sewage environment in Japan from the published literature. Our review showed that a wide variety of clinically important antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARGs), and antimicrobial residues are present in human wastewater in Japan. Their concentrations are lower than in low- and middle-income countries (LMICs) and are further reduced by sewage treatment plants (STPs) before discharge. Nevertheless, the remaining ARB and ARGs could be an important source of AMR contamination in river water. Furthermore, hospital effluence may be an important reservoir of clinically important ARB. The high concentration of antimicrobial agents commonly prescribed in Japan may contribute to the selection and dissemination of AMR within wastewater. Our review shows the importance of both monitoring for AMR and antimicrobials in human wastewater and efforts to reduce their contamination load in wastewater.

What is the effect on antibiotic resistant genes of chlorine disinfection in drinking water supply systems? A systematic review protocol

BACKGROUND

Antibiotic-resistant bacteria (ARB) usually enter water sources in different ways, such as via municipal and hospital wastewaters. Because conventional technologies used to treat water inefficient in removing these contaminants (especially antibiotic-resistant genes; ARGs), these contaminants easily enter drinking water distribution networks and pose serious threats to consumers' health. This study's main purpose is to systematically investigate the effect of chlorine disinfection on ARGs in drinking water supply systems. This study could play an important role in elucidating the effect of chlorine disinfection on ARGs.

METHODS

The systematic review outlining this protocol will be performed according to the Collaboration for Environmental Evidence (CEE) guidelines. The main question is, "what is the effect of chlorine disinfection on ARGs in drinking water supply systems?" For this purpose, the articles will be considered, in which chlorine's effect on ARGs is investigated. The search includes electronic resources, grey literature, and related websites. Electronic resources include Scopus, PubMed, Embase, Web of Science Core Collection, and Science Direct. After the final search, the obtained articles will be collected in the reference management software (Endnote X8). Upon removing the duplicate articles, the first stage of article screening will be performed based on the title and abstract the articles. In the second stage, the articles obtained from the first screening stage will be screened based on the full text of the articles based on the eligibility criteria. Then, two members of the expert team extract the data. To assess the validity of the articles, bias sources will be determined by an expert team. Biases will be defined according to the criteria designed by Bilotta et al. Finally, a narrative synthesis will be performed for the extracted data; if appropriate data are available, quantitative analysis will also be performed.

Disinfection of polymicrobial urines by electrochemical oxidation: Removal of antibiotic-resistant bacteria and genes

In this work, data obtained from the University Hospital Complex of Albacete (Spain) were selected as a case study to carry out the disinfection experiments. To do this, different configurations of electrochemical reactors were tested for the disinfection of complex urines. Results showed that 4-6 logs bacterial removal were achieved for every bacterium tested when working with a microfluidic flow-through reactor after 180 min (0.423 Ah dm^-3). The MIKROZON® cell reached a total disinfection after 60 min (1.212 Ah dm^-3), causing severe damages induced in the cell walls observed in SEM images. The concentration profiles of the electrogenerated disinfectants in solution could explain the differences observed. Additionally, a mean decrease in the ARGs concentration ranked as follows: bla_KPC (4.18-logs) > bla_TEM (3.96-logs) > ermB (3.23-logs) using the MIKROZON® cell. This electro-ozonizer could be considered as a suitable alternative to reduce the risk of antibiotic resistance spread. Hence, this study provides an insight into different electrochemical reactors for the disinfection of complex hospital urine matrices and contributes to reduce the spread of antibiotic resistance through the elimination of ARGs. A topic of great importance nowadays that needs to be further studied.

Electrochemical Technologies to Decrease the Chemical Risk of Hospital Wastewater and Urine

The inefficiency of conventional biological processes to remove pharmaceutical compounds (PhCs) in wastewater is leading to their accumulation in aquatic environments. These compounds are characterized by high toxicity, high antibiotic activity and low biodegradability, and their presence is causing serious environmental risks. Because much of the PhCs consumed by humans are excreted in the urine, hospital effluents have been considered one of the main routes of entry of PhCs into the environment. In this work, a critical review of the technologies employed for the removal of PhCs in hospital wastewater was carried out. This review provides an overview of the current state of the developed technologies for decreasing the chemical risks associated with the presence of PhCs in hospital wastewater or urine in the last years, including conventional treatments (filtration, adsorption, or biological processes), advanced oxidation processes (AOPs) and electrochemical advanced oxidation processes (EAOPs).