Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Pharmaceuticals in Wastewater Treatment Plants: A Systematic Review on the Substances of Greatest Concern Responsible for the Development of Antimicrobial Resistance

Version 1 : Received: 25 June 2021 / Approved: 28 June 2021 / Online: 28 June 2021 (14:53:01 CEST)

A peer-reviewed article of this Preprint also exists.

Frascaroli, G.; Reid, D.; Hunter, C.; Roberts, J.; Helwig, K.; Spencer, J.; Escudero, A. Pharmaceuticals in Wastewater Treatment Plants: A Systematic Review on the Substances of Greatest Concern Responsible for the Development of Antimicrobial Resistance. Appl. Sci. 2021, 11, 6670. Frascaroli, G.; Reid, D.; Hunter, C.; Roberts, J.; Helwig, K.; Spencer, J.; Escudero, A. Pharmaceuticals in Wastewater Treatment Plants: A Systematic Review on the Substances of Greatest Concern Responsible for the Development of Antimicrobial Resistance. Appl. Sci. 2021, 11, 6670.

Journal reference: Appl. Sci. 2021, 11, 6670
DOI: 10.3390/app11156670

Abstract

In recent years, there is a growing concern about the alarming spread of antimicrobial resistance (AMR) in different environments. Increasingly, many species of bacteria, fungi and viruses are becoming immune to the most commonly used pharmaceuticals. One of the causes of the development of the resistance is the persistence of these drugs, excreted by humans, in municipal and hospital wastewater (WW). Consequently, wastewater treatment plants (WWTPs) are a primary source of antimicrobial resistance genes as novel pollutants. This systematic review sought to examine the relevant literature on pharmaceutical residues (PRs) responsible for AMR in municipal and hospital WW in order to propose a classification of the PRs of greatest concern and provide an updated source for AMR management in WWTPs. Among 546 studies collected from four databases, 18 were included in the present review. The internal and external validity of each study was assessed, and the risk of bias was evaluated on a 20-parameter basis. Results were combined in a narrative synthesis discussing influents and effluents PR concentrations at 88 WWTPs, seasonal variations, differences between hospital and municipal WW, environmental risk assessment values of antimicrobial substances and treatment facilities removal efficiencies. Among the 45 PRs responsible for AMR evaluated in this study, the antibiotics ciprofloxacin, clarithromycin, erythromycin, metronidazole, ofloxacin, sulfamethoxazole and trimethoprim constitute a considerable risk in terms of ubiquitous distribution, worrying concentrations, risk quotients values, and resistance to removal treatments. Gaps in knowledge, data and information reported in this review provide a valuable source for managing AMR in WWTPs.

Subject Areas

Wastewater; Pharmaceutical residues; Antimicrobial Resistance; Wastewater treatment plants; Occurrence; Removal; Environmental Risk Assessment; Classification

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