{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:21:55Z","timestamp":1790612515329,"version":"4.1.0"},"reference-count":75,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T00:00:00Z","timestamp":1636329600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"South African Medical Research Council (SAMRC) as a sub-grant received from the Bill and Melinda Gates Foundation","award":["96086"],"award-info":[{"award-number":["96086"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Essential components of public health include strengthening the surveillance of infectious diseases and developing early detection and prevention policies. This is particularly important for drug-resistant tuberculosis (DR-TB), which can be explored by using wastewater-based surveillance. This study aimed to use molecular techniques to determine the occurrence and concentration of antibiotic-resistance genes (ARGs) associated with tuberculosis (TB) resistance in untreated and treated wastewater. Raw\/untreated and treated (post-chlorination) wastewater samples were taken from three wastewater treatment plants (WWTPs) in South Africa. The ARGs were selected to target drugs used for first- and second-line TB treatment. Both conventional polymerase chain reaction (PCR) and the more advanced droplet digital PCR (ddPCR) were evaluated as surveillance strategies to determine the distribution and concentration of the selected ARGs. The most abundant ARG in the untreated wastewater was the rrs gene, associated with resistance to the aminoglycosides, specifically streptomycin, with median concentration ranges of 4.69\u20135.19 log copies\/mL. In contrast, pncA gene, associated with resistance to the TB drug pyrazinamide, was the least detected (1.59 to 2.27 log copies\/mL). Resistance genes associated with bedaquiline was detected, which is a significant finding because this is a new drug introduced in South Africa for the treatment of multi-drug resistant TB. This study, therefore, establishes the potential of molecular surveillance of wastewater for monitoring antibiotic resistance to TB treatment in communities.<\/jats:p>","DOI":"10.3390\/antibiotics10111362","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T08:05:16Z","timestamp":1636358716000},"page":"1362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Wastewater-Based Surveillance of Antibiotic Resistance Genes Associated with Tuberculosis Treatment Regimen in KwaZulu Natal, South Africa"],"prefix":"10.3390","volume":"10","author":[{"given":"Hlengiwe N.","family":"Mtetwa","sequence":"first","affiliation":[{"name":"Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa"},{"name":"Institute for Water and Wastewater Technology (IWWT), Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac D.","family":"Amoah","sequence":"additional","affiliation":[{"name":"Institute for Water and Wastewater Technology (IWWT), Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheena","family":"Kumari","sequence":"additional","affiliation":[{"name":"Institute for Water and Wastewater Technology (IWWT), Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8108-0238","authenticated-orcid":false,"given":"Faizal","family":"Bux","sequence":"additional","affiliation":[{"name":"Institute for Water and Wastewater Technology (IWWT), Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0197-8951","authenticated-orcid":false,"given":"Poovendhree","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,8]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2016). WHO Treatment Guidelines for Drug-Resistant Tuberculosis, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.scitotenv.2020.137580","article-title":"Occurrence of antibiotics and risk of antibiotic resistance evolution in selected Kenyan wastewaters, surface waters and sediments","volume":"720","author":"Kairigo","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.watres.2014.02.003","article-title":"Insights into the relationship between antimicrobial residues and bacterial populations in a hospital-urban wastewater treatment plant system","volume":"54","author":"Varela","year":"2014","journal-title":"Water Res."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Suthar, A.B., Moonan, P.K., and Alexander, H.L. (2018). Towards national systems for continuous surveillance of antimicrobial resistance: Lessons from tuberculosis. PLoS Med., 15.","DOI":"10.1371\/journal.pmed.1002658"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5313","DOI":"10.1016\/j.vaccine.2015.07.090","article-title":"Profiling the host immune response to tuberculosis vaccines","volume":"33","author":"Fletcher","year":"2015","journal-title":"Vaccine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6285","DOI":"10.1128\/AEM.01492-12","article-title":"Molecular survey of the occurrence of Legionella spp., Mycobacterium spp., Pseudomonas aeruginosa, and amoeba hosts in two chloraminated drinking water distribution systems","volume":"78","author":"Wang","year":"2012","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Cox, H., Dickson-Hall, L., Ndjeka, N., van\u2019t Hoog, A., Grant, A., Cobelens, F., Stevens, W., and Nicol, M. (2017). Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB\/RIF in South Africa: A retrospective cohort study. PLoS Med., 14.","DOI":"10.1371\/journal.pmed.1002238"},{"key":"ref_8","unstructured":"World Health Organization WHO Global Tuberculosis Report 2018, Available online: https:\/\/www.who.int\/tb\/publications\/global_report\/gtbr2018_main_text_28Feb2019.pdf."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s11157-017-9438-x","article-title":"Status of pathogens, antibiotic resistance genes and antibiotic residues in wastewater treatment systems","volume":"16","author":"Nnadozie","year":"2017","journal-title":"Rev. Environ. Sci. Bio\/Technol."},{"key":"ref_10","unstructured":"Nguyen, Q.H. (2016). Genetic Determinants, and Evolution of Drug Resistance in Mycobacterium Tuberculosis in Vietnam: Toward New Diagnostic Tools. [Ph.D. Thesis, Universit\u00e9 Montpellier]."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.coph.2018.05.013","article-title":"Drug-resistant tuberculosis: Challenges and opportunities for diagnosis and treatment","volume":"42","author":"Koch","year":"2018","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.5588\/ijtld.20.0174","article-title":"Implementing novel regimens for drug-resistant TB in South Africa: What can the world learn?","volume":"24","author":"Ndjeka","year":"2020","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1179\/2047773215Y.0000000030","article-title":"Antimicrobial resistance: A global multifaceted phenomenon","volume":"109","author":"Prestinaci","year":"2015","journal-title":"Pathog. Glob. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/trstmh\/trx050","article-title":"Antimicrobial resistance: A One Health perspective","volume":"111","author":"Kahn","year":"2017","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1089\/mdr.2011.0063","article-title":"Mutations in the rrs A1401G gene and phenotypic resistance to amikacin and capreomycin in Mycobacterium tuberculosis","volume":"18","author":"Sirgel","year":"2012","journal-title":"Microb. Drug Resist."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.scitotenv.2013.01.032","article-title":"Urban wastewater treatment plants as hotspots for antibiotic resistant bacteria and genes spread into the environment: A review","volume":"447","author":"Rizzo","year":"2013","journal-title":"Sci. Total Environ."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102245","DOI":"10.1016\/j.jece.2018.03.004","article-title":"Prevalence of antibiotics and antibiotic resistance genes in a wastewater effluent-receiving river in the Netherlands","volume":"8","author":"Sabri","year":"2020","journal-title":"J. Environ. Chem. Eng."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.watres.2015.08.045","article-title":"Fate of pharmaceuticals in full-scale source separated sanitation system","volume":"85","author":"Butkovskyi","year":"2015","journal-title":"Water Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"739","DOI":"10.3390\/w4030739","article-title":"Discussion on sustainable water technologies for peri-urban areas of Mexico City: Balancing urbanization and environmental conservation","volume":"4","author":"Nanninga","year":"2012","journal-title":"Water"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.coesh.2020.04.006","article-title":"The potential of wastewater-based epidemiology as surveillance and early warning of infectious disease outbreaks","volume":"17","author":"Mao","year":"2020","journal-title":"Curr. Opin. Environ. Sci. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"139631","DOI":"10.1016\/j.scitotenv.2020.139631","article-title":"Wastewater surveillance for population-wide Covid-19: The present and future","volume":"736","author":"Daughton","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"105689","DOI":"10.1016\/j.envint.2020.105689","article-title":"Future perspectives of wastewater-based epidemiology: Monitoring infectious disease spread and resistance to the community level","volume":"139","author":"Sims","year":"2020","journal-title":"Environ. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"659","DOI":"10.7196\/SAMJ.2019.v109i9.13730","article-title":"Prevalence of isoniazid resistance-conferring mutations associated with multidrug-resistant tuberculosis in Free State Province, South Africa","volume":"109","author":"Pitso","year":"2019","journal-title":"S. Afr. Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e00589","DOI":"10.1002\/mbo3.589","article-title":"A closer look at the antibiotic-resistant bacterial community found in urban wastewater treatment systems","volume":"7","author":"Tehrani","year":"2018","journal-title":"Microbiol. Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.jglr.2014.01.008","article-title":"Patterns of age-0 yellow perch growth, diets, and mortality in Saginaw Bay, Lake Huron","volume":"40","author":"Rodwell","year":"2014","journal-title":"J. Great Lakes Res."},{"key":"ref_26","unstructured":"Department of Health (DOH) Republic of South Africa (2015). Introduction of New Drugs and Drug Regimens for the Management of Drug-Resistant Tuberculosis in South Africa: Policy Framework Version."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ijid.2016.10.026","article-title":"Classifying new anti-tuberculosis drugs: Rationale and future perspectives","volume":"56","author":"Tiberi","year":"2017","journal-title":"Int. J. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1038\/ja.2014.107","article-title":"Resistance to rifampicin: A review","volume":"67","author":"Goldstein","year":"2014","journal-title":"J. Antibiot."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"625078","DOI":"10.3389\/fphar.2021.625078","article-title":"Adherence and associated factors of treatment regimen in drug-susceptible tuberculosis patients","volume":"12","author":"Bea","year":"2021","journal-title":"Front. Pharmacol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e96","DOI":"10.1016\/S2666-5247(20)30195-6","article-title":"Globally diverse Mycobacterium tuberculosis resistance acquisition: A retrospective geographical and temporal analysis of whole genome sequences","volume":"2","author":"Ektefaie","year":"2021","journal-title":"Lancet Microbe"},{"key":"ref_31","first-page":"2","article-title":"Etiology and antimicrobial susceptibility patterns of bacterial agents causing urinary tract infection in children under five years, dar es salaam","volume":"2","author":"Kadigi","year":"2020","journal-title":"J. Biotechnol. Immunol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.5588\/ijtld.15.0389","article-title":"Mechanisms of drug resistance in Mycobacterium tuberculosis: Update 2015","volume":"19","author":"Zhang","year":"2015","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1093\/jac\/dku457","article-title":"Comprehensive physicochemical, pharmacokinetic and activity profiling of anti-TB agents","volume":"70","author":"Lakshminarayana","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jmii.2012.08.020","article-title":"rrs and rpsL mutations in streptomycin-resistant isolates of Mycobacterium tuberculosis from Mexico","volume":"46","year":"2013","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.meegid.2012.12.013","article-title":"Characterization of pncA gene mutations in pyrazinamide-resistant Mycobacterium tuberculosis isolates from Mexico","volume":"19","author":"Cuellar","year":"2013","journal-title":"Infect. Genet. Evol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1164\/rccm.201510-2091OC","article-title":"Genetic determinants of drug resistance in Mycobacterium tuberculosis and their diagnostic value","volume":"194","author":"Farhat","year":"2016","journal-title":"Am. J. Res. Crit. Care Med."},{"key":"ref_37","first-page":"601","article-title":"Status of streptomycin resistance development in Xanthomonas oryzae pv. oryzae and Xanthomonas oryzae pv. oryzicola in China and their resistance characters","volume":"158","author":"Xu","year":"2010","journal-title":"J. Phytopathol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"4039","DOI":"10.1007\/s00216-018-1010-1","article-title":"Critical assessment of digital PCR for the detection and quantification of genetically modified organisms","volume":"410","author":"Demeke","year":"2018","journal-title":"Anal. Bioanal. Chem."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1042\/BSR20181170","article-title":"Application of droplet digital PCR to detect the pathogens of infectious diseases","volume":"38","author":"Li","year":"2018","journal-title":"Biosci. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ijid.2020.07.045","article-title":"Using droplet digital PCR in the detection of Mycobacterium tuberculosis DNA in FFPE samples","volume":"99","author":"Cao","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-020-65766-8","article-title":"Survey of drug resistance associated gene mutations in Mycobacterium tuberculosis, ESKAPE and other bacterial species","volume":"10","author":"Ghosh","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e01427-17","DOI":"10.1128\/AAC.01427-17","article-title":"Molecular mechanisms of intrinsic streptomycin resistance in Mycobacterium abscessus","volume":"62","author":"Molin","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Dai, R., He, J., Zha, X., Wang, Y., Zhang, X., Gao, H., Yang, X., Li, J., Xin, Y., and Wang, Y. (2021). A novel mechanism of streptomycin resistance in Yersinia pestis: Mutation in the rpsL gene. PLoS Negl. Trop. Dis., 15.","DOI":"10.1371\/journal.pntd.0009324"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e00860-20","DOI":"10.1128\/AAC.00860-20","article-title":"Evidence for expanding the role of streptomycin in the management of drug-resistant Mycobacterium tuberculosis","volume":"64","author":"Cohen","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_45","first-page":"2713","article-title":"The roles of rpsL, rrs, and gidB mutations in predicting streptomycin-resistant drugs used on clinical Mycobacterium tuberculosis isolates from Hebei Province, China","volume":"12","author":"Wang","year":"2019","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jgar.2017.01.005","article-title":"Frequency of rrs and rpsL mutations in streptomycin-resistant Mycobacterium tuberculosis isolates from Iranian patients","volume":"9","author":"Khosravi","year":"2017","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.tube.2018.05.003","article-title":"Characterization of mutations conferring streptomycin resistance to multidrug-resistant Mycobacterium tuberculosis isolates from Myanmar","volume":"111","author":"Oo","year":"2018","journal-title":"Tuberculosis"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1089\/mdr.2020.0396","article-title":"Molecular Basis of Resistance to First-Line Drugs of Mycobacterium tuberculosis\/canettii Strains in Greece","volume":"27","author":"Florou","year":"2021","journal-title":"Microb. Drug Resist."},{"key":"ref_49","unstructured":"Padda, I.S., and Reddy, K.M. (2021, October 27). Antitubercular Medications, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557666\/."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Kraemer, S.A., Ramachandran, A.A., and Perron, G.G. (2019). Antibiotic pollution in the environment: From microbial ecology to public policy. Microorganisms, 7.","DOI":"10.3390\/microorganisms7060180"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"491","DOI":"10.3201\/eid2303.161034","article-title":"pncA gene mutations associated with pyrazinamide resistance in drug-resistant tuberculosis, South Africa and Georgia","volume":"23","author":"Allana","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Khan, M.T., Malik, S.I., Ali, S., Masood, N., Nadeem, T., Khan, A.S., and Afzal, M.T. (2019). Pyrazinamide resistance and mutations in pncA among isolates of Mycobacterium tuberculosis from Khyber Pakhtunkhwa, Pakistan. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-3764-2"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Naluyange, R., Mboowa, G., Komakech, K., Semugenze, D., Kateete, D.P., and Ssengooba, W. (2020). High prevalence of phenotypic pyrazinamide resistance and its association with pncA gene mutations in Mycobacterium tuberculosis isolates from Uganda. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0232543"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/S2213-2600(18)30235-2","article-title":"Effect of bedaquiline on mortality in South African patients with drug-resistant tuberculosis: A retrospective cohort study","volume":"6","author":"Schnippel","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e00628-17","DOI":"10.1128\/AAC.00628-17","article-title":"Digital PCR for detection and quantification of fluoroquinolone resistance in Legionella pneumophila","volume":"61","author":"Hennebique","year":"2017","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Barancheshme, F., and Munir, M. (2019). Development of antibiotic resistance in wastewater treatment plants. Antimicrobial Resistance-A Global Threat, IntechOpen.","DOI":"10.5772\/intechopen.81538"},{"key":"ref_57","first-page":"887","article-title":"Monitoring and comparison of antibiotic resistant bacteria and their resistance genes in municipal and hospital wastewaters","volume":"5","author":"Aali","year":"2014","journal-title":"Int. J. Prev. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.ijheh.2019.01.002","article-title":"Non-tuberculous mycobacteria in drinking water systems: A review of prevalence data and control means","volume":"222","author":"Dumoutier","year":"2019","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"660","DOI":"10.3390\/microorganisms7120660","article-title":"Linking microbial community composition in treated wastewater with water quality in distribution systems and subsequent health effects","volume":"7","author":"Abasiofiok","year":"2019","journal-title":"Microorganisms"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s11274-016-2012-9","article-title":"Bacterial communities in full-scale wastewater treatment systems","volume":"32","author":"Magdalena","year":"2016","journal-title":"World J. Microbiol. Biotechnol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e00739-17","DOI":"10.1128\/JB.00739-17","article-title":"The many lives of nontuberculous mycobacteria","volume":"200","author":"Claeys","year":"2018","journal-title":"J. Bacteriol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Cui, B., and Liang, S. (2019). Monitoring opportunistic pathogens in domestic wastewater from a pilot-scale anaerobic biofilm reactor to reuse in agricultural irrigation. Water, 11.","DOI":"10.3390\/w11061283"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"563","DOI":"10.3343\/alm.2018.38.6.563","article-title":"Delamanid, bedaquiline, and linezolid minimum inhibitory concentration distributions and resistance-related gene mutations in multidrug-resistant and extensively drug-resistant tuberculosis in Korea","volume":"38","author":"Yang","year":"2018","journal-title":"Ann. Lab. Med."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Samer, M. (2015). Biological and chemical wastewater treatment processes. Wastewater Treatment Engineering, IntechOpen.","DOI":"10.5772\/61250"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2599","DOI":"10.3389\/fmicb.2018.02599","article-title":"Reduction of antibiotic resistant bacteria during conventional and advanced wastewater treatment, and the disseminated loads released to the environment","volume":"9","author":"Hembach","year":"2018","journal-title":"Front. Microbiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1007\/s00253-015-7202-0","article-title":"Antibiotic resistance in urban aquatic environments: Can it be controlled?","volume":"100","author":"Manaia","year":"2016","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1016\/j.scitotenv.2018.08.130","article-title":"Performance of secondary wastewater treatment methods for the removal of contaminants of emerging concern implicated in crop uptake and antibiotic resistance spread: A review","volume":"648","author":"Krzeminski","year":"2019","journal-title":"Sci. Total Environ."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"28","DOI":"10.3389\/fcimb.2018.00028","article-title":"Environmental Mycobacterium avium subsp. paratuberculosis hosted by free-living amoebae","volume":"8","author":"Robino","year":"2018","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.3389\/fmicb.2017.02603","article-title":"Strategies to combat antibiotic resistance in the wastewater treatment plants","volume":"8","author":"Barancheshme","year":"2018","journal-title":"Front. Microbiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/jac\/dkx316","article-title":"Identification of novel mutations associated with cycloserine resistance in Mycobacterium tuberculosis","volume":"72","author":"Chen","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_71","unstructured":"Cross, X., and Buckley, C. (2021, March 14). SFD Promotion Initiative. SFD Report Durban, South Africa. Available online: www.sfd.susana.org."},{"key":"ref_72","first-page":"686","article-title":"Detection of Drug Resistant Genes of Mycobacterium Tuberculosis in Sudanese Tuberculosis Patients in Khartoum State Using Multiplex PCR","volume":"14","author":"Elhussein","year":"2018","journal-title":"EC Microbiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1128\/JCM.05570-11","article-title":"Rapid identification of mycobacteria and drug-resistant Mycobacterium tuberculosis by use of a single multiplex PCR and DNA sequencing","volume":"50","author":"Boyle","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"147273","DOI":"10.1016\/j.scitotenv.2021.147273","article-title":"Monitoring changes in COVID-19 infection using wastewater-based epidemiology: A South African perspective","volume":"786","author":"Pillay","year":"2021","journal-title":"Sci. Total Environ."},{"key":"ref_75","unstructured":"World Health Organization (2014). Briefing Note: Antimicrobial Resistance: An Emerging Water, Sanitation and Hygiene Issue, World Health Organization."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/11\/1362\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:27:20Z","timestamp":1760167640000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/11\/1362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,8]]},"references-count":75,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["antibiotics10111362"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics10111362","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,8]]}}}