Does Chlorination Promote Antimicrobial Resistance in Waterborne Pathogens? Mechanistic Insight into Co-Resistance and Its Implication for Public Health

Abstract

Chemical agents including chlorine and antibiotics are used extensively to control infectious microorganisms. While antibiotics are mainly used to treat bacterial infections, chlorine is widely used for microbial inactivation in the post-secondary disinfection steps of water treatment. The extensive use of these agents has been acknowledged as a driving force for the expansion of antimicrobial resistance (AMR) and has prompted discourse on their roles in the evolution and proliferation of resistant pathogens in the aquatic milieus. We live in a possible “post-antibiotic” era when resistant microbes spread at startling levels with dire predictions relating to a potential lack of effective therapeutic antibacterial drugs. There have been reports of enhancement of resistance among some waterborne pathogens due to chlorination. In this context, it is pertinent to investigate the various factors and mechanisms underlying the emergence and spread of resistance and the possible association between chlorination and AMR. We, therefore, reflect on the specifics of bacterial resistance development, the mechanisms of intrinsic and acquired resistance with emphasis on their environmental and public health implications, the co-selection for antibiotic resistance due to chlorination, biofilm microbiology, and multidrug efflux activity. In-depth knowledge of the molecular basis of resistance development in bacteria will significantly contribute to the more rational utilization of these biocidal agents and aid in filling identified knowledge gap toward curbing resistance expansion.

Antibacterial Activity of Solvothermal Obtained ZnO Nanoparticles with Different Morphology and Photocatalytic Activity against a Dye Mixture: Methylene Blue, Rhodamine B and Methyl Orange

“…The traditional methods for water purification include processes, e.g., sedimentation [ 4 ], flotation [ 5 ], filtration [ 6 ], adsorption [ 7 ], or chlorination [ 8 ], but the associated costs are important and they have limitations (e.g., do not remove the antibiotics). The use of nanomaterials for water purification is still in its infancy.…”

The Impact of Chlorine Disinfection of Hospital Wastewater on Clonal Similarity and ESBL-Production in Selected Bacteria of the Family Enterobacteriaceae

“…Various mechanisms underlying resistance to chlorine compounds have been identified in bacterial strains, including changes in membrane permeability, increased expression of efflux pumps, overproduction of extracellular substances or capsule materials, biofilm production, changes in metabolism, or integration with protozoa. However, many of these mechanisms remain unknown [ 8 ]. In the present study, clones were detected only in HWW samples collected in two successive seasons (spring-summer; summer-autumn; autumn-winter).…”

“…However, chlorine can also damage nucleic acids and affect enzyme activity [ 7 ]. Bacteria can survive high chlorine concentrations, such as 2.0 mg/L free chlorine for 1 h [ 8 ]. Chlorine-injured bacteria can regrow, and their biological activity can be restored [ 9 ].…”

Bacterial-Nanocellulose-Based Biointerfaces and Biomimetic Constructs for Blood-Contacting Medical Applications

“…HASMCs were magnetized with dextran coated IONs through passive uptake, and a parallel plate flow chamber with a magnetic field was used to seed the magnetized BNC. However, the magnetized BNC was not found to significantly improve cell attachment or proliferation when compared to unmodified BNC . While these studies tested the effect of magnetic forces on the cell adhesion and proliferation to BNC membranes, no hemocompatibility tests were performed.…”

“…NIPAM is a temperature sensitive polymer and therefore has been studied for thermal responsive applications. Additionally, chlorine is a well-known disinfectant; however, the exact mechanism is poorly understood . To fabricate the membranes, NIPAM was chemically grafted to BNC using triethoxyvinylsilane, followed by immersion in a hypochlorite solution to chlorinate the membrane.…”