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 ].…”

Contribution to the Synthesis, Characterization, Separation and Quantification of New N-Acyl Thiourea Derivatives with Antimicrobial and Antioxidant Potential

“…The Gram-negative bacilli, both glucose-fermentative (E. coli) and non-fermentative (P. aeruginosa), are involved in endogenous and exogenous infections that are very difficult to treat due to their multiple intrinsic and acquired resistance sometimes to the majority (extendeddrug resistance) or even all tested antibiotics (pan-drug resistance), including last resorts such as plasmid-mediated colistin resistance [40,41]. The resistance determinants are often located on mobile genetic elements facilitating their escape from clinical settings to the community and the environment [42,43]. In addition to their genetic resistance, these opportunistic pathogens have also the ability to develop sessile communities on different tissues or implanted devices, and are very tolerant to high antibiotic concentrations.…”

The COVID-19 Pandemic Impact of Hospital Wastewater on Aquatic Systems in Bucharest

“…Unfortunately, the antibacterial antibiotic resistance effect due to an increase in pharmaceutical compounds usage was more enhanced by an unregulated antimicrobial use and a lack of proper worldwide-accepted protocols. In addition, the mix between antibiotic and biocides generated an increase in antibiotic-resistant bacteria [27].…”