Towards risk assessment for antibiotic resistant pathogens in recycled water: a systematic review and summary of research needs

Abstract

Risk assessment is critical for identifying target concentrations of antibiotic resistant pathogens necessary for mitigating potential harmful exposures associated with water reuse. However, there is currently limited available data characterizing the concentrations of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) in recycled water to support robust efforts at risk assessment. The objective of this systematic review was to identify and synthesize the existing literature documenting the presence and abundance of ARB and ARGs in recycled water. In addition, this review identifies best practices and explores monitoring targets for studying ARB and ARGs in recycled water to guide future work and identifies key research needs aimed at better supporting quantitative microbial risk assessment focused on recycled water and antibiotic resistance. Future efforts to collect data about ARB and ARG prevalence in recycled water should report concentration data per unit volume. Sample metadata should also be provided, including a description of treatment approach, a description of planned water uses (e.g., potable, irrigation), methods for conveyance to the point of use, and available physicochemical water quality data. Additional research is needed aimed at identifying recommended ARB and ARG monitoring targets and for developing approaches to incorporate metagenomic data into risk assessment.

Reclamation of Treated Wastewater for Irrigation in Chile: Perspectives of the Current State and Challenges

“…The SLR enables a qualitative analysis (evaluation and interpretation) and is used when the scope of a review is specific and the dataset small and manageable enough such that its content can be manually reviewed [37]. Recently, SLR has been used to evaluate the use of reclaimed water, but in very specific studies of organic compounds present in wastewater [38][39][40]. SLRs follow well-defined and transparent steps and always require the following: a definition of the question or problem, identification and critical appraisal of the available evidence, synthesis of the findings, and the drawing of relevant conclusions [36].…”

Managing emerging pathogen risks in recycled water

“…17 Another area of uncertainty is the emerging risk posed by antimicrobial resistance (AMR), where there is potential for complex but as-yet uncharacterised risks (acute and diffuse) arising from both AMR genes and organisms at various exposure points across wastewater treatment and water recycling systems. [23][24][25][26] Some of these knowledge gaps will be the subject of future research to be undertaken by the newly established Cooperative Research Centre for Solving Antimicrobial Resistance in Agribusiness, Food, and Environments (CRC SAAFE; https://www.crcsaafe.com.au) (Fig. 3).…”

A neglected risk of nanoplastics as revealed by the promoted transformation of plasmid‐borne ampicillin resistance gene by Escherichia coli

“…Antibiotic resistance is a grand challenge that needs to be addressed in this century (Garner et al, 2021; Vikesland et al, 2017) since its dissemination in the environment eventually contributes at a certain level to antibiotic‐resistant infections in humans (Pruden, 2014). The effect of plastic pollution on the dissemination of antibiotic resistance has recently attracted much attention (Bank et al, 2020; Dick Vethaak & Legler, 2021).…”