Frontiers in Microbiology (May 2023)
Wastewater treatment plants, an “escape gate” for ESCAPE pathogens
- Luminita Gabriela Marutescu,
- Luminita Gabriela Marutescu,
- Marcela Popa,
- Irina Gheorghe-Barbu,
- Irina Gheorghe-Barbu,
- Ilda Czobor Barbu,
- Ilda Czobor Barbu,
- Daloha Rodríguez-Molina,
- Daloha Rodríguez-Molina,
- Daloha Rodríguez-Molina,
- Fanny Berglund,
- Fanny Berglund,
- Hetty Blaak,
- Carl-Fredrik Flach,
- Carl-Fredrik Flach,
- Merel Aurora Kemper,
- Beate Spießberger,
- Beate Spießberger,
- Beate Spießberger,
- Laura Wengenroth,
- D. G. Joakim Larsson,
- D. G. Joakim Larsson,
- Dennis Nowak,
- Dennis Nowak,
- Katja Radon,
- Ana Maria de Roda Husman,
- Andreas Wieser,
- Andreas Wieser,
- Andreas Wieser,
- Heike Schmitt,
- Gratiela Pircalabioru Gradisteanu,
- Gratiela Pircalabioru Gradisteanu,
- Gratiela Pircalabioru Gradisteanu,
- Corneliu Ovidiu Vrancianu,
- Mariana Carmen Chifiriuc,
- Mariana Carmen Chifiriuc,
- Mariana Carmen Chifiriuc
Affiliations
- Luminita Gabriela Marutescu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Luminita Gabriela Marutescu
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Marcela Popa
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Irina Gheorghe-Barbu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Irina Gheorghe-Barbu
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Ilda Czobor Barbu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Ilda Czobor Barbu
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Daloha Rodríguez-Molina
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Daloha Rodríguez-Molina
- Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, LMU Munich, Munich, Germany
- Daloha Rodríguez-Molina
- Pettenkofer School of Public Health, Munich, Germany
- Fanny Berglund
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Fanny Berglund
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
- Hetty Blaak
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Carl-Fredrik Flach
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Carl-Fredrik Flach
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
- Merel Aurora Kemper
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Beate Spießberger
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Beate Spießberger
- 0Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
- Beate Spießberger
- 1Department of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
- Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- D. G. Joakim Larsson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- D. G. Joakim Larsson
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
- Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Dennis Nowak
- 2Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
- Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Ana Maria de Roda Husman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Andreas Wieser
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Andreas Wieser
- 0Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
- Andreas Wieser
- 1Department of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
- Heike Schmitt
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Gratiela Pircalabioru Gradisteanu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Gratiela Pircalabioru Gradisteanu
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Gratiela Pircalabioru Gradisteanu
- 3Romanian Academy of Sciences, Bucharest, Romania
- Corneliu Ovidiu Vrancianu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Mariana Carmen Chifiriuc
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Mariana Carmen Chifiriuc
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Mariana Carmen Chifiriuc
- 4The Romanian Academy, Bucharest, Romania
- DOI
- https://doi.org/10.3389/fmicb.2023.1193907
- Journal volume & issue
-
Vol. 14
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.
Keywords
- ESCAPE pathogens
- antibiotic resistance
- wastewater treatment plants
- antibiotic resistance genes
- ESCAPE species dissemination
- high-risk clones
