La Rosa Maria Clara, Maugeri Andrea, Favara Giuliana, La Mastra Claudia, Magnano San Lio Roberta, Barchitta Martina, Agodi Antonella
Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123 Catania, Italy.
Antibiotics (Basel). 2025 Jan 26;14(2):131. doi: 10.3390/antibiotics14020131.
BACKGROUND/OBJECTIVES: Antimicrobial resistance (AMR) is a global issue driven by the overuse of antibiotics in healthcare, agriculture, and veterinary settings. Wastewater and treatment plants (WWTPs) act as reservoirs for antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs). The One Health approach emphasizes the interconnectedness of human, animal, and environmental health in addressing AMR. This scoping review analyzes wastewater's role in the AMR spread, identifies influencing factors, and highlights research gaps to guide interventions.
This scoping review followed the PRISMA-ScR guidelines. A comprehensive literature search was conducted across the PubMed and Web of Science databases for articles published up to June 2024, supplemented by manual reference checks. The review focused on wastewater as a source of AMR, including hospital effluents, industrial and urban sewage, and agricultural runoff. Screening and selection were independently performed by two reviewers, with conflicts resolved by a third.
Of 3367 studies identified, 70 met the inclusion criteria. The findings indicated that antibiotic residues, heavy metals, and microbial interactions in wastewater are key drivers of AMR development. Although WWTPs aim to reduce contaminants, they often create conditions conducive to horizontal gene transfer, amplifying resistance. Promising interventions, such as advanced treatment methods and regulatory measures, exist but require further research and implementation.
Wastewater plays a pivotal role in AMR dissemination. Targeted interventions in wastewater management are essential to mitigate AMR risks. Future studies should prioritize understanding AMR dynamics in wastewater ecosystems and evaluating scalable mitigation strategies to support global health efforts.
背景/目的：抗菌药物耐药性（AMR）是一个全球性问题，由医疗保健、农业和兽医领域抗生素的过度使用所驱动。废水处理厂（WWTPs）充当了抗生素耐药菌（ARB）和抗生素耐药基因（ARGs）的储存库。“同一健康”方法强调在应对AMR时人类、动物和环境健康的相互关联性。本综述分析了废水在AMR传播中的作用，确定了影响因素，并突出了研究空白以指导干预措施。
本综述遵循PRISMA-ScR指南。在PubMed和Web of Science数据库中对截至2024年6月发表的文章进行了全面的文献检索，并辅以手动参考文献检查。该综述聚焦于废水作为AMR来源的情况，包括医院废水、工业和城市污水以及农业径流。筛选和选择由两名评审员独立进行，如有冲突则由第三名评审员解决。
在识别出的3367项研究中，70项符合纳入标准。研究结果表明，废水中的抗生素残留、重金属和微生物相互作用是AMR发展的关键驱动因素。尽管污水处理厂旨在减少污染物，但它们常常创造有利于水平基因转移的条件，从而增强耐药性。虽然存在如先进处理方法和监管措施等有前景的干预措施，但仍需要进一步研究和实施。
废水在AMR传播中起着关键作用。针对废水管理的有针对性干预对于降低AMR风险至关重要。未来的研究应优先了解废水生态系统中的AMR动态，并评估可扩展的缓解策略以支持全球卫生工作。
