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Do wastewater treatment plants increase antibiotic resistant bacteria or genes in the environment? Protocol for a systematic review.

ABSTRACT: BACKGROUND:Antibiotic resistance is a global public health threat. Water from human activities is collected at wastewater treatment plants where processes often do not sufficiently neutralize antibiotic resistant bacteria and genes, which are further shed into the local environment. This protocol outlines the steps to conduct a systematic review based on the Population, Exposure, Comparator and Outcome (PECO) framework, aiming at answering the question "Are antimicrobial-resistant enterobacteriaceae and antimicrobial resistance genes present (O) in air and water samples (P) taken either near or downstream or downwind or down-gradient from wastewater treatment plants (E), as compared to air and water samples taken either further away or upstream or upwind or up-gradient from such wastewater treatment plant (C)?" Presence of antimicrobial-resistant bacteria and genes will be quantitatively measured by extracting their prevalence or concentration, depending on the reviewed study. METHODS:We will search PubMed, EMBASE, the Cochrane database and Web of Science for original articles published from 1 Jan 2000 to 3 Sep 2018 with language restriction. Articles will undergo a relevance and a design screening process. Data from eligible articles will be extracted by two independent reviewers. Further, we will perform a risk of bias assessment using a decision matrix. We will synthesize and present results in narrative and tabular form and will perform a meta-analysis if heterogeneity of results allows it. DISCUSSION:Antibiotic resistance in environmental samples around wastewater treatment plants may pose a risk of exposure to workers and nearby residents. Results from the systematic review outlined in this protocol will allow to estimate the extend of exposure, to inform policy making and help to design future studies.

SUBMITTER: Rodriguez-Molina D

PROVIDER: S-EPMC6894476 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Do wastewater treatment plants increase antibiotic resistant bacteria or genes in the environment? Protocol for a systematic review.

Rodríguez-Molina Daloha D Mang Petra P Schmitt Heike H Schmitt Heike H Chifiriuc Mariana Carmen MC Radon Katja K Wengenroth Laura L

Systematic reviews 20191205 1

<h4>Background</h4>Antibiotic resistance is a global public health threat. Water from human activities is collected at wastewater treatment plants where processes often do not sufficiently neutralize antibiotic resistant bacteria and genes, which are further shed into the local environment. This protocol outlines the steps to conduct a systematic review based on the Population, Exposure, Comparator and Outcome (PECO) framework, aiming at answering the question "Are antimicrobial-resistant entero ...[more]

PMID: 31806019

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Project description:BackgroundThe widespread and unrestricted use of antibiotics has led to the emergence and spread of antibiotic-resistant bacteria (ARB), antibiotic-resistance genes (ARGs), and antibiotic residues in the environment. Conventional wastewater treatment plants (WWTPs) are not designed for effective and adequate removal of ARB, ARGs, and antibiotic residues, and therefore, they play an important role in the dissemination of antimicrobial resistance (AMR) in the natural environment.ObjectiveWe will conduct a systematic review to determine the most effective treatment strategies for the removal of ARB, ARGs, and antibiotic residues from the treated effluent disposed into the environment from WWTPs that receive municipal, hospital, and domestic discharge.MethodsWe will search the MEDLINE, EMBASE, Web of Science, World Health Organization Global Index Medicus, and ProQuest Environmental Science Collection databases for full-text peer-reviewed journal articles published between January 2001 and December 2020. We will select only articles published in the English language. We will include studies that measured (1) the presence, concentration, and removal rate of ARB/ARGs going from WWTP influent to effluent, (2) the presence, concentration, and types of antibiotics in the effluent, and (3) the possible selection of ARB in the effluent after undergoing treatment processes in WWTPs. At least two independent reviewers will extract data and perform risk of bias assessment. An acceptable or narrative synthesis method will be followed to synthesize the data and present descriptive characteristics of the included studies in a tabular form. The study has been approved by the Ethics Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh (protocol number: PR-20113).ResultsThis protocol outlines our proposed methodology for conducting a systematic review. Our results will provide an update to the existing literature by searching additional databases.ConclusionsFindings from our systematic review will inform the planning of proper treatment methods that can effectively reduce the levels of ARB, ARGs, and residual antibiotics in effluent, thus lowering the risk of the environmental spread of AMR and its further transmission to humans and animals.International registered report identifier (irrid)PRR1-10.2196/33365.

Project description:The occurrence of new chemical and microbiological contaminants in the aquatic environment has become an issue of increasing environmental concern. Thus, wastewater treatment plants (WWTPs) play an important part in the distribution of so-called new emerging pathogens and antibiotic resistances. Therefore, the daily loads released by the WWTP were calculated including a model system for the distribution of these loads within the receiving water body. UV-, as well as ozone-treatment in separate or in combination for wastewater treatment were under investigation aiming at the reduction of these loads. Here, the impact of these treatments on the DNA integrity via antibody staining and PCR efficiencies experiments were included. All three facultative pathogenic bacteria [enterococci (23S rRNA), Pseudomonas aeruginosa (ecfX), and Escherichia coli (yccT)] and seven clinically relevant antibiotic resistance genes (ARGs) (mecA (methicillin resistance gene), ctx-M32 (β- lactame resistance gene), ermB (erythromycine resistance gene), bla TEM (β- lactame resistance gene), sul1 (sulfonamide resistance gene), vanA (vancomycin resistance gene), and intI1 (Integrase1 gene) associated with mobile genetic elements were detected in wastewaters. Different reduction efficiencies were analyzed during advanced wastewater treatments. ARGs were still found to be present in the effluents under the parameters of 1.0 g ozone per g dissolved organic carbon (DOC) and 400 J/m2, like ctx-M32, ermB, bla TEM, sul1, and intI1. Especially UV radiation induced thymidine dimerization which was analyzed via antibody mediated detection in the metagenome of the natural wastewater population. These specific DNA alterations were not observed during ozone treatment and combinations of UV/ozone treatment. The dimerization or potential other DNA alterations during UV treatment might be responsible for a decreased PCR efficiency of the 16S rRNA amplicons (176, 490, and 880 bp fragments) from natural metagenomes compared to the untreated sample. This impact on PCR efficiencies was also observed for the combination of ozone and UV treatment.

Project description:BackgroundQuantification of acquisition routes of antibiotic resistant bacteria (ARB) is pivotal for understanding transmission dynamics and designing cost-effective interventions. Different methods have been used to quantify the importance of transmission routes, such as relative risks, odds ratios (OR), genomic comparisons and basic reproduction numbers. We systematically reviewed reported estimates on acquisition routes' contributions of ARB in humans, animals, water and the environment and assessed the methods used to quantify the importance of transmission routes.MethodsPubMed and EMBASE were searched, resulting in 6054 articles published up until January 1st, 2019. Full text screening was performed on 525 articles and 277 are included.ResultsWe extracted 718 estimates with S. aureus (n = 273), E. coli (n = 157) and Enterobacteriaceae (n = 99) being studied most frequently. Most estimates were derived from statistical methods (n = 560), mainly expressed as risks (n = 246) and ORs (n = 239), followed by genetic comparisons (n = 85), modelling (n = 62) and dosage of ARB ingested (n = 17). Transmission routes analysed most frequently were occupational exposure (n = 157), travelling (n = 110) and contacts with carriers (n = 83). Studies were mostly performed in the United States (n = 142), the Netherlands (n = 87) and Germany (n = 60). Comparison of methods was not possible as studies using different methods to estimate the same route were lacking. Due to study heterogeneity not all estimates by the same method could be pooled.ConclusionDespite an abundance of published data the relative importance of transmission routes of ARB has not been accurately quantified. Links between exposure and acquisition are often present, but the frequency of exposure is missing, which disables estimation of transmission routes' importance. To create effective policies reducing ARB, estimates of transmission should be weighed by the frequency of exposure occurrence.

Project description:Contaminated sites are recognized as the "hotspot" for the development and spread of antibiotic resistance in environmental bacteria. It is very challenging to understand mechanism of development of antibiotic resistance in polluted environment in the presence of different anthropogenic pollutants. Uncertainties in the environmental processes adds complexity to the development of resistance. This study attempts to develop mathematical model by using stochastic partial differential equations for the transport of fluoroquinolone and its resistant bacteria in riverine environment. Poisson's process is assumed for the diffusion approximation in the stochastic partial differential equations (SPDE). Sensitive analysis is performed to evaluate the parameters and variables for their influence over the model outcome. Based on their sensitivity, the model parameters and variables are chosen and classified into environmental, demographic, and anthropogenic categories to investigate the sources of stochasticity. Stochastic partial differential equations are formulated for the state variables in the model. This SPDE model is then applied to the 100 km stretch of river Musi (South India) and simulations are carried out to assess the impact of stochasticity in model variables on the resistant bacteria population in sediments. By employing the stochasticity in model variables and parameters we came to know that environmental and anthropogenic variations are not able to affect the resistance dynamics at all. Demographic variations are able to affect the distribution of resistant bacteria population uniformly with standard deviation between 0.087 and 0.084, however, is not significant to have any biological relevance to it. The outcome of the present study is helpful in simplifying the model for practical applications. This study is an ongoing effort to improve the model for the transport of antibiotics and transport of antibiotic resistant bacteria in polluted river. There is a wide gap between the knowledge of stochastic resistant bacterial growth dynamics and the knowledge of transport of antibiotic resistance in polluted aquatic environment, this study is one step towards filling up that gap.

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Do wastewater treatment plants increase antibiotic resistant bacteria or genes in the environment? Protocol for a systematic review.

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Do wastewater treatment plants increase antibiotic resistant bacteria or genes in the environment? Protocol for a systematic review.

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