Antimicrobial pharmaceuticals are classified as emergent micropollutants of concern, implying that even at low concentrations, long-term exposure to the environment can have significant eco-toxicological effects. There is a lack of a standardized regulatory framework governing the permissible antibiotic content for monitoring environmental water quality standards. Therefore, indiscriminate discharge of antimicrobials at potentially active concentrations into urban wastewater treatment facilities is rampant. Antimicrobials may exert selective pressure on bacteria, leading to resistance development and eventual health consequences. The emergence of clinically important multiple antibiotic-resistant bacteria in untreated hospital effluents and wastewater treatment plants (WWTPs) has been linked to the continuous exposure of bacteria to antimicrobials. The levels of environmental exposure to antibiotics and their correlation to the evolution and spread of resistant bacteria need to be elucidated to help in the formulation of mitigation measures. This review explores frequently detected antimicrobials in wastewater and gives a comprehensive coverage of bacterial resistance mechanisms to different antibiotic classes through the expression of a wide variety of antibiotic resistance genes either inherent and/or exchanged among bacteria or acquired from the reservoir of antibiotic resistance genes (ARGs) in wastewater systems. To complement the removal of antibiotics and ARGs from WWTPs, upscaling the implementation of prospective interventions such as vaccines, phage therapy, and natural compounds as alternatives to widespread antibiotic use provides a multifaceted approach to minimize the spread of antimicrobial resistance.

Antimicrobials in wastewater promote the emergence of antibiotic resistance, facilitated by selective pressure and transfer of resistant genes. Enteric bacteria belonging to Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, and Citrobacter species (n = 126) from hospital effluents and proximate wastewater treatment plant were assayed for susceptibility to four antimicrobial classes. The β-lactamase encoding genes harbored in plasmids were genotyped and the plasmids were sequenced. A multidrug resistance phenotype was found in 72% (n = 58) of E. coli isolates, 70% (n = 43) of Klebsiella species isolates, and 40% (n = 25) of Enterobacter and Citrobacter species. Moreover, 86% (n = 50) of E. coli, 77% (n = 33) of Klebsiella species, and 25% (n = 4) of Citrobacter species isolates phenotypically expressed extended spectrum β-lactamase. Regarding ESBL genes, bla_CTX-M-27 and bla_TEM-1 were found in E. coli, while Klebsiella species harbored bla_CTX-M-15, bla_CTX-M-30, or bla_SHV-12. Genes coding for aminoglycoside modifying enzymes, adenylyltransferases (aadA1, aadA5), phosphotransferases (aph(6)-1d, aph(3″)-Ib), acetyltransferases (aac(3)-IIa), (aac(6)-Ib), sulfonamide/trimethoprim resistant dihydropteroate synthase (sul), dihydrofolate reductase (dfrA), and quinolone resistance protein (qnrB1) were also identified. Monitoring wastewater from human sources for acquired resistance in clinically important bacteria may provide a cheaper alternative in regions facing challenges that limit clinical surveillance.

We present plasmid sequences of 21 multidrug resistant isolates of Enterobacterales belonging to Escherichia coli (n=10), Klebsiella pneumoniae (n=9), Klebsiella oxytoca (n=1), and Citrobacter freundii (n=1). The isolates originated from effluent collected from hospital sewer pipes and from a wastewater treatment plant (WWTP) in a southwestern Hungarian city. Isolation was carried out using eosin methylene blue agar supplemented with ceftriaxone and the isolates were identified with MALDI-TOF MS. Screening for multidrug resistance was conducted by determining susceptibility to four chemical classes namely, beta-lactams, aminoglycoside, fluoroquinolone, and sulfonamide. Plasmid DNA was isolated by alkaline lysis method using the Monarch plasmid DNA miniprep kit from freshly grown pure colonies. Molecular typing and Illumina sequencing of plasmid DNA of multiresistant strains were performed. After the assembly of contigs, genes localized on plasmid sequences were determined and functionally annotated. These reconstructed plasmid sequences supplemented with gene functional annotations were deposited in the Mendeley data. Using these datasets different plasmid incompatibility groups were identified. These conjugative plasmids appear to play a key role in the transmission of multiple resistance genes in enteric bacteria via wastewater. The presented data may provide useful insight on the correlations between environmental antibiotic contamination and the development of bacterial resistance, which poses a serious public health threat.