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Review

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

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Department of Civil Engineering and Environmental Management, School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, Scotland, UK
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Department of Applied Science, School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, Scotland, UK
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Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, Scotland, UK
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Author to whom correspondence should be addressed.
Academic Editor: Nídia Dana Lourenço
Appl. Sci. 2021, 11(15), 6670; https://doi.org/10.3390/app11156670
Received: 25 June 2021 / Revised: 13 July 2021 / Accepted: 16 July 2021 / Published: 21 July 2021
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 influent and effluent 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 quotient values and resistance to removal treatments. Gaps in knowledge, data and information reported in this review will provide a valuable source for managing AMR in WWTPs. View Full-Text
Keywords: wastewater; pharmaceutical residues; antimicrobial resistance; wastewater treatment plants; occurrence; removal; environmental risk assessment; classification wastewater; pharmaceutical residues; antimicrobial resistance; wastewater treatment plants; occurrence; removal; environmental risk assessment; classification
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MDPI and ACS Style

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. https://doi.org/10.3390/app11156670

AMA Style

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. Applied Sciences. 2021; 11(15):6670. https://doi.org/10.3390/app11156670

Chicago/Turabian Style

Frascaroli, Gabriele, Deborah Reid, Colin Hunter, Joanne Roberts, Karin Helwig, Janice Spencer, and Ania Escudero. 2021. "Pharmaceuticals in Wastewater Treatment Plants: A Systematic Review on the Substances of Greatest Concern Responsible for the Development of Antimicrobial Resistance" Applied Sciences 11, no. 15: 6670. https://doi.org/10.3390/app11156670

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