From Conventional Disinfection to Antibiotic Resistance Control-Status of the Use of Chlorine and UV Irradiation during Wastewater Treatment

Non-thermal obliteration of critically ranked carbapenem-resistant Acinetobacter baumannii and its resistance gene in a batch atmospheric plasma reactor

Wastewater treatment plants (WWTPs) have been implicated as direct key reservoir of both antibiotic-resistant bacteria (ARB) and antibiotic-resistant genes (ARGs) associated with human infection, as high concentrations of ARBs and ARGs have been detected in recycled hospital wastewater. Among the ARBs, the carbapenem-resistant Acinetobacter baumannii has been ranked as priority 1 (critical) pathogen by the World Health Organization (WHO), due to its overwhelming burden on public health. Therefore, this study is aimed at investigating non-thermal plasma (NTP) technology as an alternative disinfection step to inactivate this bacterium and its ARGs. Culture-based method and PCR were employed in confirming the carbapenem resistance gene blaNDM-1 in A. baumannii (BAA 1605). Suspension of carbapenem-resistant A. baumannii (24 h culture) was prepared from the confirmed isolate and subjected to plasma treatment at varying time intervals (3 min, 6 min, 9 min, 12 min, and 15 min) in triplicates. The plasma-treated samples were evaluated for re-growth and the presence of the resistance gene. The treatment resulted in a 1.13 log reduction after 3 min and the highest log reduction of ≥ 8 after 15 min, and the results also showed that NTP was able to inactivate the blaNDM-1 gene. The log reduction and gel image results suggest that plasma disinfection has a great potential to be an efficient tertiary treatment step for WWTPs.

The Role of Wastewater Treatment Plants in Dissemination of Antibiotic Resistance: Source, Measurement, Removal and Risk Assessment

Antibiotic Resistance Genes (ARGs) are contaminants of emerging concern with marked potential to impact public and environmental health. This review focusses on factors that influence the presence, abundance, and dissemination of ARGs within Wastewater Treatment Plants (WWTPs) and associated effluents. Antibiotic-Resistant Bacteria (ARB) and ARGs have been detected in the influent and the effluent of WWTPs worldwide. Different levels of wastewater treatment (primary, secondary, and tertiary) show different degrees of removal efficiency of ARGs, with further differences being observed when ARGs are captured as intracellular or extracellular forms. Furthermore, routinely used molecular methodologies such as quantitative polymerase chain reaction or whole genome sequencing may also vary in resistome identification and in quantifying ARG removal efficiencies from WWTP effluents. Additionally, we provide an overview of the One Health risk assessment framework, as well as future strategies on how WWTPs can be assessed for environmental and public health impact.

Systematic analysis of the scientific-technological production on the use of the UV, H2O2, and/or Cl2 systems in the elimination of bacteria and associated antibiotic resistance genes

This study presents a systematic review of the scientific and technological production related to the use of systems based on UV, H2O2, and Cl2 for the elimination of antibiotic-resistant bacteria (ARB) and genes associated with antibiotic resistance (ARGs). Using the Pro Know-C (Knowledge Development Process-Constructivist) methodology, a portfolio was created and analyzed that includes 19 articles and 18 patents published between 2011 and 2022. The results show a greater scientific-technological production in UV irradiation systems (8 articles and 5 patents) and the binary combination UV/H2O2 (9 articles and 4 patents). It was emphasized that UV irradiation alone focuses mainly on the removal of ARB, while the addition of H2O2 or Cl2, either individually or in binary combinations with UV, enhances the removal of ARB and ARG. The need for further research on the UV/H2O2/Cl2 system is emphasized, as gaps in the scientific-technological production of this system (0 articles and 2 patents), especially in its electrochemically assisted implementation, have been identified. Despite the gaps identified, there are promising prospects for the use of combined electrochemically assisted UV/H2O2/Cl2 disinfection systems. This is demonstrated by the effective removal of a wide range of contaminants, including ARB, fungi, and viruses, as well as microorganisms resistant to conventional disinfectants, while reducing the formation of toxic by-products.

Calcined Bean Dregs-Hydrocalumite Composites as Efficient Adsorbents for the Removal of Ofloxacin

Calcined bean dregs-hydrocalumite composites were prepared through in situ self-assembly of hydrocalumite on the surface of bean dregs and used for the adsorption of ofloxacin from water. The adsorbents were characterized by scanning electron microscopy, X-ray powder diffraction, and N2 physical adsorption. The results showed that the adsorption performance of calcined bean dregs-hydrocalumite composites for ofloxacin was much better than that of a single bean dreg carbon or calcined hydrocalumite. The effects of preparation and adsorption conditions on the adsorption property of calcined bean dregs-hydrocalumite for ofloxacin were also investigated. The adsorption ratio of ofloxacin reached up to 99.93% using 4 g·L-1 adsorbent dosage with 20 mg·L-1 initial concentration of ofloxacin at 30 °C in 2 h. The adsorption process mainly occurred in the first 5 min. In addition, the adsorption of ofloxacin by calcined bean dregs-hydrocalumite was more in line with pseudo-second-order dynamics and the Langmuir isotherm model.

The dynamics and removal efficiency of antibiotic resistance genes by UV-LED treatment: An integrated research on single- or dual-wavelength irradiation

Antimicrobial resistance has gained increasing attention, because of the awareness of its potential health risks. Strategies for the removal of antibiotic resistance genes (ARGs) are urgently required. In the present study, UV-LEDs at wavelength of 265 and 285 nm were integrated at five conditions, including single 265 nm UV-LED, single 285 nm UV-LED, and combined 265 nm and 285 nm UV-LED at different intensities, to remove tet A, cat 1, and amp C. The ARGs removal efficiency, gene behavior, and possible cellular mechanism were analyzed using real-time quantitative PCR, flow cytometry, and transmission electron microscopy (TEM). The 265 nm UV-LED is more effective than the 285 nm UV-LED and their combinations in terms of ARGs control, in which 1.91, 1.71, and 1.45 log were removed for tet A, cat 1, and amp C, respectively, at a UV dosage of 500 mJ/cm2. The intracellular gene leakage was detected in all five UV-LED experiment scenarios even when the cell membrane damage was insignificant with the highest increase of 0.69 log ARGs. ROS was generated during the irradiation, and the ROS was strongly negative correlated with intracellular ARGs, which could promote the degradation and removal of ARGs. This study provides a new insight of intracellular ARGs removal, because direct irradiation, ROS oxidation, and leakage to the extracellular serve as the three main pathways under high-dosage UV-LED irradiation. Further research should be focused on the mechanism and optimization of UV technology with 265 nm UV-LED for ARG control.

Persistent transmission of carbapenem-resistant, hypervirulent Klebsiella pneumoniae between a hospital and urban aquatic environments

The increasing prevalence of infections caused by carbapenem-resistant hypervirulent Klebsiella pneumoniae strains (CR-hvKP) prompts the question of whether these strains also circulate outside of clinical settings. However, the environmental occurrence and dissemination of CR-hvKP are poorly studied. In the current study, we investigated the epidemiological characteristics, and dissemination dynamics of carbapenem-resistant K. pneumoniae (CRKP) isolated from a hospital, an urban wastewater treatment plant (WWTP), and adjacent rivers in Eastern China during one year of monitoring. A total of 101 CRKP were isolated, 54 were determined to be CR-hvKP harboring pLVPK-like virulence plasmids, which were isolated from the hospital (29 out of 51), WWTP (23 out of 46), and rivers (2 out of 4), respectively. The period with lowest detection rate of CR-hvKP in the WWTP, August, corresponded with the lowest detection rate at the hospital. Comparing the inlet and outlet of the WWTP, no significant reduction of the detection of CR-hvKP and relative abundance of carbapenem resistance genes was observed. The detection rate of CR-hvKP and the relative abundance of carbapenemase genes were significantly higher in the WWTP in colder months compared to warmer months. Clonal dissemination of CR-hvKP clones of ST11-KL64 between the hospital and the aquatic environment, as well as the horizontal spread of IncFII-IncR and IncC plasmids carrying carbapenemase genes, was observed. Furthermore, phylogenetic analysis showed that the ST11-KL64 CR-hvKP strain has spread nationally by interregional transmission. These results indicated transmission of CR-hvKP clones between hospital and urban aquatic environments, prompting the need for improved wastewater disinfection and epidemiological models to predict the public health hazard from prevalence data of CR-hvKP.

New trajectories of technologies for the removal of pollutants and emerging contaminants in the environment

Modern society has increasingly a diffusion of pollutants and emerging contaminants (e.g., different types of chemicals and endocrine disruptors in pharmaceuticals, pesticides, household cleaning, and personal care products, etc.) that have detrimental effects on the environment (atmosphere, hydrosphere, biosphere and anthroposphere) and also generate diseases and disorders on the people health. Environmental science requires efforts in the detection and elimination of manifold pollutants and emerging pollutants with appropriate product and process technologies. This study aims to analyze different paths of treatment technologies to investigate their evolution and predict new directions of promising technological trajectories to support the removal of contaminants directed to reach, whenever possible, sustainable development objectives. The work is mainly devoted to wastewater treatment technologies. A proposed model analyzes the evolution of patents (proxy of innovation and new technology) on publications (proxy of science and knowledge advances) to quantify the relative growth rate of new trajectories of technologies to remove pollutants and emerging contaminants. Results reveal that new directions of treatment technologies having an accelerated rate of growth are (in decreasing order): biochar and reverse osmosis in physical-based technologies, coagulation, and disinfection water treatments in chemical-based technologies and anaerobic processes in biological-based technologies. Other main technologies, such as carbon nanotubes and advanced oxidation processes, seem to be in the initial phase of development and need learning by using processes and further science and technology advances to be implemented as effective treatments and cost-effective. The results here are in accord with global water and wastewater equipment treatment market revenues by technology, showing a similar trend. These findings bring us to the main information to extend the knowledge about new directions of technologies for the treatment and/or elimination of pollutants and microorganisms that can support decisions of policymakers towards goals of sustainable development by reducing environmental degradation and people health disorders.

Surveillance on ESBL-Escherichia coli and Indicator ARG in Wastewater and Reclaimed Water of Four Regions of Spain: Impact of Different Disinfection Treatments

In the present study, the occurrence of indicator antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) both in the influent and the effluent of four Spanish wastewater treatment plants (WWTPs) was monitored for 12 months, and the susceptibility profiles of 89 recovered extended spectrum β-lactamase (ESBL)-producing Escherichia coli isolates were obtained against a wide range of antimicrobials. The aim of the study was to better understand whether the current wastewater treatment practices allow us to obtain safe reclaimed water mitigating the spread of ARB and ARGs to the environment. Results showed high concentrations of ESBL-producing E. coli as well as a high prevalence of a range of ARGs in the influent samples. The reclamation treatments implemented in the WWTPs were effective in reducing both the occurrence of ESBL E. coli and ARGs, although significant differences were observed among WWTPs. Despite these reductions in occurrence observed upon wastewater treatment, our findings suggest that WWTP effluents may represent an important source of ARGs, which could be transferred among environmental bacteria and disseminate antimicrobial resistance through the food chain. Remarkably, no major differences were observed in the susceptibility profiles of the ESBL E. coli isolated from influent and effluent waters, indicating that water treatments do not give rise to the emergence of new resistance phenotypes.

Inactivation of antibiotic-resistant bacteria and antibiotic-resistance genes in wastewater streams: Current challenges and future perspectives

The discovery of antibiotics, which was once regarded as a timely medical intervention now leaves a bitter aftertaste: antimicrobial resistance (AMR), due to the unregulated use of these compounds and the poor management receiving wastewaters before discharge into pristine environments or the recycling of such treated waters. Wastewater treatment plants (WWTPs) have been regarded a central sink for the mostly unmetabolized or partially metabolised antibiotics and is also pivotal to the incidence of antibiotic resistance bacteria (ARBs) and their resistance genes (ARGs), which consistently contribute to the global disease burden and deteriorating prophylaxis. In this regard, we highlighted WWTP-antibiotics consumption-ARBs-ARGs nexus, which might be critical to understanding the epidemiology of AMR and also guide the precise prevention and remediation of such occurrences. We also discovered the unsophistication of conventional WWTPs and treatment techniques for adequate treatment of antibiotics, ARBs and ARGs, due to their lack of compliance with environmental sustainability, then ultimately assessed the prospects of cold atmospheric plasma (CAP). Herein, we observed that CAP technologies not only has the capability to disinfect wastewater polluted with copious amounts of chemicals and biologicals, but also have a potential to augment bioelectricity generation, when integrated into bio electrochemical modules, which future WWTPs should be retrofitted to accommodate. Therefore, further research should be conducted to unveil more of the unknowns, which only a snippet has been highlighted in this study.