Wastewater treatment plants, an “escape gate” for ESCAPE pathogens

Abstract

Antibiotics are an essential tool of modern medicine, contributing to significantly decreasing mortality and morbidity rates from infectious diseases. However, persistent misuse of these drugs has accelerated the evolution of antibiotic resistance, negatively impacting clinical practice. The environment contributes to both the evolution and transmission of resistance. From all anthropically polluted aquatic environments, wastewater treatment plants (WWTPs) are probably the main reservoirs of resistant pathogens. They should be regarded as critical control points for preventing or reducing the release of antibiotics, antibiotic-resistant bacteria (ARB), and antibiotic-resistance genes (ARGs) into the natural environment. This review focuses on the fate of the pathogens Enterococcus faecium, Staphylococcus aureus, Clostridium difficile, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae spp. (ESCAPE) in WWTPs. All ESCAPE pathogen species, including high-risk clones and resistance determinants to last-resort antibiotics such as carbapenems, colistin, and multi-drug resistance platforms, were detected in wastewater. The whole genome sequencing studies demonstrate the clonal relationships and dissemination of Gram-negative ESCAPE species into the wastewater via hospital effluents and the enrichment of virulence and resistance determinants of S. aureus and enterococci in WWTPs. Therefore, the efficiency of different wastewater treatment processes regarding the removal of clinically relevant ARB species and ARGs, as well as the influence of water quality factors on their performance, should be explored and monitored, along with the development of more effective treatments and appropriate indicators (ESCAPE bacteria and/or ARGs). This knowledge will allow the development of quality standards for point sources and effluents to consolidate the WWTP barrier role against the environmental and public health AR threats.

Quantitative detection and reduction of potentially pathogenic bacterial groups of Aeromonas, Arcobacter, Klebsiella pneumoniae species complex, and Mycobacterium in wastewater treatment facilities

“…Therefore, further viability-qPCR assay-based surveys [ 81 ] may provide additional insights into the development and appropriate management of WTFs to produce safe and hygienic water. In addition, the correlation between antibiotic-resistant bacteria, antibiotic-resistance genes, and water quality parameters should be further investigated to comprehensively reduce health risks associated with the discharge and use of treated wastewater [ 82 ]. Furthermore, certain Aeromonas , Arcobacter , and Mycobacterium members can be highly resistant to chlorine disinfection, which is the most cost-effective disinfection method [ 83 ].…”

Inactivation of antibiotic-resistant bacteria Escherichia coli by electroporation

“…Another problematic reservoir for antibiotic-resistant bacteria and also for antibiotics and antibiotic-resistance genes is wastewater from hospitals and livestock farms, due to the excessive use of antibiotics in these facilities ( Avatsingh et al, 2023 ; Marutescu et al, 2023 ; Mehanni et al, 2023 ). Therefore, thorough surveillance of wastewater is essential to protect public health and the environment ( Tiwari et al, 2022 ).…”