{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:59:31Z","timestamp":1793386771688,"version":"4.5.0"},"reference-count":99,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,26]],"date-time":"2025-01-26T00:00:00Z","timestamp":1737849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Antimicrobial resistance (AMR) is a global issue driven by the overuse of antibiotics in healthcare, agriculture, and veterinary settings. Wastewater and treatment plants (WWTPs) act as reservoirs for antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs). The One Health approach emphasizes the interconnectedness of human, animal, and environmental health in addressing AMR. This scoping review analyzes wastewater\u2019s role in the AMR spread, identifies influencing factors, and highlights research gaps to guide interventions. Methods: This scoping review followed the PRISMA-ScR guidelines. A comprehensive literature search was conducted across the PubMed and Web of Science databases for articles published up to June 2024, supplemented by manual reference checks. The review focused on wastewater as a source of AMR, including hospital effluents, industrial and urban sewage, and agricultural runoff. Screening and selection were independently performed by two reviewers, with conflicts resolved by a third. Results: Of 3367 studies identified, 70 met the inclusion criteria. The findings indicated that antibiotic residues, heavy metals, and microbial interactions in wastewater are key drivers of AMR development. Although WWTPs aim to reduce contaminants, they often create conditions conducive to horizontal gene transfer, amplifying resistance. Promising interventions, such as advanced treatment methods and regulatory measures, exist but require further research and implementation. Conclusions: Wastewater plays a pivotal role in AMR dissemination. Targeted interventions in wastewater management are essential to mitigate AMR risks. Future studies should prioritize understanding AMR dynamics in wastewater ecosystems and evaluating scalable mitigation strategies to support global health efforts.<\/jats:p>","DOI":"10.3390\/antibiotics14020131","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T04:59:10Z","timestamp":1737953950000},"page":"131","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":153,"title":["The Impact of Wastewater on Antimicrobial Resistance: A Scoping Review of Transmission Pathways and Contributing Factors"],"prefix":"10.3390","volume":"14","author":[{"given":"Maria Clara","family":"La Rosa","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2655-8574","authenticated-orcid":false,"given":"Andrea","family":"Maugeri","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliana","family":"Favara","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"La Mastra","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2023-2135","authenticated-orcid":false,"given":"Roberta","family":"Magnano San Lio","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0905-5003","authenticated-orcid":false,"given":"Martina","family":"Barchitta","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4405-8162","authenticated-orcid":false,"given":"Antonella","family":"Agodi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,26]]},"reference":[{"key":"ref_1","first-page":"567","article-title":"Part IV. Human infections and antibiotic resistance","volume":"101","author":"Govender","year":"2011","journal-title":"S. Afr. Med. J."},{"key":"ref_2","unstructured":"O\u2019neill, J.I.M. (2014). Antimicrobial resistance: Tackling a crisis for the health and wealth of nations. Rev. Antimicrob. Resist."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jgar.2021.08.001","article-title":"Environmental antimicrobial resistance and its drivers: A potential threat to public health","volume":"27","author":"Samreen","year":"2021","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1038\/nrmicro3439","article-title":"Tackling antibiotic resistance: The environmental framework","volume":"13","author":"Berendonk","year":"2015","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_5","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_6","unstructured":"Wang, G. (2017). Synergy of antimicrobial peptides. Antimicrobial Peptides: Discovery, Design Novel Therapeutic Strategies, CABI."},{"key":"ref_7","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_8","doi-asserted-by":"crossref","first-page":"138788","DOI":"10.1016\/j.scitotenv.2020.138788","article-title":"Antibiotic-resistant bacteria and antimicrobial residues in wastewater and process water from German pig slaughterhouses and their receiving municipal wastewater treatment plants","volume":"727","author":"Savin","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e02748-19","DOI":"10.1128\/AEM.02748-19","article-title":"ESKAPE Bacteria and Extended-Spectrum-\u03b2-Lactamase-Producing Escherichia coli Isolated from Wastewater and Process Water from German Poultry Slaughterhouses","volume":"86","author":"Savin","year":"2020","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.mib.2021.05.001","article-title":"Quantitative analysis of horizontal gene transfer in complex systems","volume":"62","author":"Moralez","year":"2021","journal-title":"Curr. Opin. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wang, Z., Zhang, X.X., Huang, K., Miao, Y., Shi, P., Liu, B., Long, C., and Li, A. (2013). Metagenomic profiling of antibiotic resistance genes and mobile genetic elements in a tannery wastewater treatment plant. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0076079"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1111\/1574-6976.12062","article-title":"Bacterial diversity and antibiotic resistance in water habitats: Searching the links with the human microbiome","volume":"38","author":"Nunes","year":"2014","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1038\/s41467-018-07992-3","article-title":"Fecal pollution can explain antibiotic resistance gene abundances in anthropogenically impacted environments","volume":"10","author":"Karkman","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.scitotenv.2018.05.165","article-title":"Relationship between modification of activated sludge wastewater treatment and changes in antibiotic resistance of bacteria","volume":"639","author":"Korzeniewska","year":"2018","journal-title":"Sci. Total Environ."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/j.envint.2018.10.032","article-title":"Prevalence and transmission of antibiotic resistance and microbiota between humans and water environments","volume":"121","author":"Zhou","year":"2018","journal-title":"Environ. Int."},{"key":"ref_16","unstructured":"WHO (2020). Global Antimicrobial Resistance Surveillance System (GLASS) Report: Early Implementation 2020, World Health Organization."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.scitotenv.2015.10.124","article-title":"Quinolone resistant Aeromonas spp. as carriers and potential tracers of acquired antibiotic resistance in hospital and municipal wastewater","volume":"542","author":"Varela","year":"2016","journal-title":"Sci. Total Environ."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"153928","DOI":"10.1016\/j.scitotenv.2022.153928","article-title":"Different fosA genes were found on mobile genetic elements in Escherichia coli from wastewaters of hospitals and municipals in Turkey","volume":"824","author":"Stingl","year":"2022","journal-title":"Sci. Total Environ."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1111\/tmi.13986","article-title":"Spread and persistence of antimicrobial resistance genes in wastewater from human and animal sources in S\u00e3o Paulo, Brazil","volume":"29","author":"Dropa","year":"2024","journal-title":"Trop. Med. Int. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1099\/mic.0.028233-0","article-title":"Detection of 140 clinically relevant antibiotic-resistance genes in the plasmid metagenome of wastewater treatment plant bacteria showing reduced susceptibility to selected antibiotics","volume":"155","author":"Szczepanowski","year":"2009","journal-title":"Microbiology"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Odih, E.E., Sunmonu, G.T., Okeke, I.N., and Dalsgaard, A. (2023). NDM-1-and OXA-23-producing. Microbiol. Spectr., 11.","DOI":"10.1128\/spectrum.02381-23"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"134660","DOI":"10.1016\/j.jhazmat.2024.134660","article-title":"Extended-spectrum \u03b2-lactamase-producing bacteria and their resistance determinants in different wastewaters and rivers in Nepal","volume":"473","author":"Khanal","year":"2024","journal-title":"J. Hazard. Mater."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.envint.2018.12.050","article-title":"Pollution from azithromycin-manufacturing promotes macrolide-resistance gene propagation and induces spatial and seasonal bacterial community shifts in receiving river sediments","volume":"123","author":"Vestergaard","year":"2019","journal-title":"Environ. Int."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Marathe, N.P., Regina, V.R., Walujkar, S.A., Charan, S.S., Moore, E.R., Larsson, D.G., and Shouche, Y.S. (2013). A treatment plant receiving waste water from multiple bulk drug manufacturers is a reservoir for highly multi-drug resistant integron-bearing bacteria. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0077310"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.watres.2019.06.073","article-title":"Industrial wastewater treatment plant enriches antibiotic resistance genes and alters the structure of microbial communities","volume":"162","author":"Milakovic","year":"2019","journal-title":"Water Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"134885","DOI":"10.1016\/j.jhazmat.2024.134885","article-title":"Anthropogenic pollution may enhance natural transformation in water, favouring the spread of antibiotic resistance genes","volume":"475","author":"Sivalingam","year":"2024","journal-title":"J. Hazard. Mater."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ecolind.2007.06.002","article-title":"Veterinary antibiotics in the aquatic and terrestrial environment","volume":"8","author":"Kemper","year":"2008","journal-title":"Ecol. Indic."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.envpol.2014.01.015","article-title":"Occurrence, sources, and fate of pharmaceuticals in aquatic environment and soil","volume":"187","author":"Li","year":"2014","journal-title":"Environ. Pollut."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2166\/wqrj.2006.039","article-title":"Pharmaceuticals and endocrine disruptors in wastewater treatment effluents and in the water supply system of Calgary, Alberta, Canada","volume":"41","author":"Chen","year":"2006","journal-title":"Water Qual. Res.J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.aca.2009.07.031","article-title":"An overview of analytical methodologies for the determination of antibiotics in environmental waters","volume":"649","author":"Lino","year":"2009","journal-title":"Anal. Chim. Acta"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.chemosphere.2008.11.086","article-title":"Antibiotics in the aquatic environment\u2014A review\u2014Part I","volume":"75","year":"2009","journal-title":"Chemosphere"},{"key":"ref_32","first-page":"25","article-title":"Sub-therapeutic use of antibiotics in animal feed and their potential impact on environmental and human health: A comprehensive review","volume":"6","author":"Kumar","year":"2018","journal-title":"J. Anim. Feed Sci. Technol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"140997","DOI":"10.1016\/j.scitotenv.2020.140997","article-title":"Occurrence and fate of antibiotics, antibiotic resistant genes (ARGs) and antibiotic resistant bacteria (ARB) in municipal wastewater treatment plant: An overview","volume":"744","author":"Wang","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1093\/jac\/49.1.25","article-title":"The 2000 Garrod lecture. Factors impacting on the problem of antibiotic resistance","volume":"49","author":"Levy","year":"2002","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"153537","DOI":"10.1016\/j.scitotenv.2022.153537","article-title":"Class 1 In-Tn5393c array contributed to antibiotic resistance of non-pathogenic Pseudoxanthomonas mexicana isolated from a wastewater bioreactor treating streptomycin","volume":"821","author":"Selvaraj","year":"2022","journal-title":"Sci. Total Environ."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"125032","DOI":"10.1016\/j.chemosphere.2019.125032","article-title":"Association between antibiotic residues, antibiotic resistant bacteria and antibiotic resistance genes in anthropogenic wastewater\u2014An evaluation of clinical influences","volume":"241","author":"Voigt","year":"2020","journal-title":"Chemosphere"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.chemosphere.2017.01.134","article-title":"Sulfamethoxazole and COD increase abundance of sulfonamide resistance genes and change bacterial community structures within sequencing batch reactors","volume":"175","author":"Guo","year":"2017","journal-title":"Chemosphere"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.chemosphere.2013.04.094","article-title":"Effects on activated sludge bacterial community exposed to sulfamethoxazole","volume":"93","author":"Collado","year":"2013","journal-title":"Chemosphere"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1289\/ehp.1104650","article-title":"Selective pressure of antibiotic pollution on bacteria of importance to public health","volume":"120","author":"Tello","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3971","DOI":"10.1007\/s00253-015-6404-9","article-title":"Impacts of coexisting antibiotics, antibacterial residues, and heavy metals on the occurrence of erythromycin resistance genes in urban wastewater","volume":"99","author":"Gao","year":"2015","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1046\/j.1462-2920.2003.00459.x","article-title":"Impact of antibiotics on conjugational resistance gene transfer in Staphylococcus aureus in sewage","volume":"5","author":"Ohlsen","year":"2003","journal-title":"Environ. Microbiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"172715","DOI":"10.1016\/j.scitotenv.2024.172715","article-title":"The combination of ciprofloxacin and dialkyldimethyl ammonium compound synergistically proliferated intracellular resistance genes in nitrifying system","volume":"930","author":"Xu","year":"2024","journal-title":"Sci. Total Environ."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jenvman.2019.02.123","article-title":"Dynamics of microbial community and tetracycline resistance genes in biological nutrient removal process","volume":"238","author":"Liu","year":"2019","journal-title":"J. Environ. Manag."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"5412","DOI":"10.1038\/s41467-024-49742-8","article-title":"Selection and horizontal gene transfer underlie microdiversity-level heterogeneity in resistance gene fate during wastewater treatment","volume":"15","author":"Brown","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Sutradhar, I., Ching, C., Desai, D., Heins, Z., Khalil, A.S., and Zaman, M.H. (2023). Effects of antibiotic interaction on antimicrobial resistance development in wastewater. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-34935-w"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.chemosphere.2018.04.135","article-title":"Long-term impact of a tetracycline concentration gradient on the bacterial resistance in anaerobic-aerobic sequential bioreactors","volume":"205","author":"Gao","year":"2018","journal-title":"Chemosphere"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3671","DOI":"10.1021\/es048468f","article-title":"Elevated microbial tolerance to metals and antibiotics in metal-contaminated industrial environments","volume":"39","author":"Stepanauskas","year":"2005","journal-title":"Environ. Sci. Technol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"15946","DOI":"10.1021\/acs.est.0c03803","article-title":"Contribution of Time, Taxonomy, and Selective Antimicrobials to Antibiotic and Multidrug Resistance in Wastewater Bacteria","volume":"54","author":"Gray","year":"2020","journal-title":"Environ. Sci. Technol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"113356","DOI":"10.1016\/j.envres.2022.113356","article-title":"Higher spreading risk of antibacterial biocide and heavy metal resistance genes than antibiotic resistance genes in aerobic granular sludge","volume":"212","author":"Li","year":"2022","journal-title":"Environ. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/j.scitotenv.2017.06.153","article-title":"Sewers as potential reservoirs of antibiotic resistance","volume":"605\u2013606","author":"Auguet","year":"2017","journal-title":"Sci. Total Environ."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"118830","DOI":"10.1016\/j.watres.2022.118830","article-title":"Reclaimed wastewater reuse in irrigation: Role of biofilms in the fate of antibiotics and spread of antimicrobial resistance","volume":"221","author":"Brienza","year":"2022","journal-title":"Water Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.jgar.2016.04.009","article-title":"Multidrug resistance and transferability of blaCTX-M among extended-spectrum \u03b2-lactamase-producing enteric bacteria in biofilm","volume":"6","author":"Maheshwari","year":"2016","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.chemosphere.2015.03.085","article-title":"Insights into the amplification of bacterial resistance to erythromycin in activated sludge","volume":"136","author":"Guo","year":"2015","journal-title":"Chemosphere"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.jbiotec.2013.08.004","article-title":"Horizontal transfer of antibiotic resistance genes in a membrane bioreactor","volume":"167","author":"Yang","year":"2013","journal-title":"J. Biotechnol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1038\/s41396-018-0277-8","article-title":"Wastewater treatment plant resistomes are shaped by bacterial composition, genetic exchange, and upregulated expression in the effluent microbiomes","volume":"13","author":"Ju","year":"2019","journal-title":"ISME J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"117854","DOI":"10.1016\/j.jenvman.2023.117854","article-title":"Anaerobic sludge digestion elevates dissemination risks of bacterial antibiotic resistance in effluent supernatant","volume":"338","author":"Li","year":"2023","journal-title":"J. Environ. Manag."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Petrovich, M., Chu, B., Wright, D., Griffin, J., Elfeki, M., Murphy, B.T., Poretsky, R., and Wells, G. (2018). Antibiotic resistance genes show enhanced mobilization through suspended growth and biofilm-based wastewater treatment processes. FEMS Microbiol. Ecol., 94.","DOI":"10.1093\/femsec\/fiy174"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.watres.2015.07.007","article-title":"Development of antibiotic resistance genes in microbial communities during long-term operation of anaerobic reactors in the treatment of pharmaceutical wastewater","volume":"83","author":"Aydin","year":"2015","journal-title":"Water Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.envint.2018.05.040","article-title":"Bacterial lineages putatively associated with the dissemination of antibiotic resistance genes in a full-scale urban wastewater treatment plant","volume":"118","author":"Rocha","year":"2018","journal-title":"Environ. Int."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"116290","DOI":"10.1016\/j.watres.2020.116290","article-title":"Synergistic effect of UV\/chlorine in bacterial inactivation, resistance gene removal, and gene conjugative transfer blocking","volume":"185","author":"Wang","year":"2020","journal-title":"Water Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"162139","DOI":"10.1016\/j.scitotenv.2023.162139","article-title":"Quantification and antibiotic resistance risk assessment of chlorination-residual viable\/VBNC Escherichia coli and Enterococcus in on-site hospital wastewater treatment system","volume":"872","author":"Jiang","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1016\/S1001-0742(12)60176-4","article-title":"Inactivation, reactivation and regrowth of indigenous bacteria in reclaimed water after chlorine disinfection of a municipal wastewater treatment plant","volume":"25","author":"Li","year":"2013","journal-title":"J. Environ. Sci."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"129563","DOI":"10.1016\/j.chemosphere.2021.129563","article-title":"Metagenomic insights into dissemination of antibiotic resistance across bacterial genera in wastewater treatment","volume":"271","author":"Cheng","year":"2021","journal-title":"Chemosphere"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1016\/j.chemosphere.2012.10.008","article-title":"Effect of chlorination and ultraviolet disinfection on tetA-mediated tetracycline resistance of Escherichia coli","volume":"90","author":"Huang","year":"2013","journal-title":"Chemosphere"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1111\/jam.12936","article-title":"Diversity and antibiotic resistance profiles of Pseudomonads from a hospital wastewater treatment plant","volume":"119","author":"Santoro","year":"2015","journal-title":"J. Appl. Microbiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"109547","DOI":"10.1016\/j.jenvman.2019.109547","article-title":"Characterization and evolution of antibiotic resistance of Salmonella in municipal wastewater treatment plants","volume":"251","author":"Zhang","year":"2019","journal-title":"J. Environ. Manag."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.watres.2018.02.036","article-title":"Chlorine disinfection increases both intracellular and extracellular antibiotic resistance genes in a full-scale wastewater treatment plant","volume":"136","author":"Liu","year":"2018","journal-title":"Water Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"122560","DOI":"10.1016\/j.envpol.2023.122560","article-title":"Free-floating extracellular DNA (exDNA) in different wastewaters: Status quo on exDNA-associated antimicrobial resistance genes","volume":"337","author":"Savin","year":"2023","journal-title":"Environ. Pollut."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"159376","DOI":"10.1016\/j.scitotenv.2022.159376","article-title":"Antibiotic resistance profile of wastewater treatment plants in Brazil reveals different patterns of resistance and multi resistant bacteria in final effluents","volume":"857","author":"Machado","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.chemosphere.2019.03.004","article-title":"Antibiotic resistant bacteria survived from UV disinfection: Safety concerns on genes dissemination","volume":"224","author":"Guo","year":"2019","journal-title":"Chemosphere"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1016\/j.envpol.2017.09.055","article-title":"Stepwise impact of urban wastewater treatment on the bacterial community structure, antibiotic contents, and prevalence of antimicrobial resistance","volume":"231","author":"Wang","year":"2017","journal-title":"Environ. Pollut."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"134330","DOI":"10.1016\/j.jhazmat.2024.134330","article-title":"Reduction of antimicrobial resistance: Advancements in nature-based wastewater treatment","volume":"471","author":"Gentile","year":"2024","journal-title":"J. Hazard. Mater."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/j.biortech.2016.07.097","article-title":"Distribution of tetracycline resistance genes in anaerobic treatment of waste sludge: The role of pH in regulating tetracycline resistant bacteria and horizontal gene transfer","volume":"218","author":"Huang","year":"2016","journal-title":"Bioresour. Technol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"30191","DOI":"10.1007\/s11356-018-2913-2","article-title":"Dynamic transport of antibiotics and antibiotic resistance genes under different treatment processes in a typical pharmaceutical wastewater treatment plant","volume":"25","author":"Li","year":"2018","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"124245","DOI":"10.1016\/j.envpol.2024.124245","article-title":"Coagulation promotes the spread of antibiotic resistance genes in secondary effluents","volume":"355","author":"Wu","year":"2024","journal-title":"Environ. Pollut."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Johansson, M.H.K., Aarestrup, F.M., and Petersen, T.N. (2023). Importance of mobile genetic elements for dissemination of antimicrobial resistance in metagenomic sewage samples across the world. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0293169"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.watres.2019.06.026","article-title":"\u03b2-lactam resistance genes in bacteriophage and bacterial DNA from wastewater, river water, and irrigation water in Washington State","volume":"161","author":"Zhang","year":"2019","journal-title":"Water Res."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1111\/j.1574-6941.2010.01034.x","article-title":"Analysis of transduction in wastewater bacterial populations by targeting the phage-derived 16S rRNA gene sequences","volume":"76","author":"Flanagan","year":"2011","journal-title":"FEMS Microbiol. Ecol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"6965","DOI":"10.1038\/s41467-021-27037-6","article-title":"Multi-species host range of staphylococcal phages isolated from wastewater","volume":"12","author":"Elsener","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.ijantimicag.2017.08.013","article-title":"Phages in urban wastewater have the potential to disseminate antibiotic resistance","volume":"50","author":"Gunathilaka","year":"2017","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/j.ecoenv.2019.01.047","article-title":"Evolution of microbial community and drug resistance during enrichment of tetracycline-degrading bacteria","volume":"171","author":"Wang","year":"2019","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Delgado-Blas, J.F., Ovejero, C.M., David, S., Montero, N., Calero-Caceres, W., Garcillan-Barcia, M.P., de la Cruz, F., Muniesa, M., Aanensen, D.M., and Gonzalez-Zorn, B. (2021). Population genomics and antimicrobial resistance dynamics of Escherichia coli in wastewater and river environments. Commun. Biol., 4.","DOI":"10.1038\/s42003-021-01949-x"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.1038\/s41396-019-0446-4","article-title":"Linking the resistome and plasmidome to the microbiome","volume":"13","author":"Stalder","year":"2019","journal-title":"ISME J."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s00253-008-1829-z","article-title":"Antibiotic resistance genes in water environment","volume":"82","author":"Zhang","year":"2009","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/j.jenvman.2013.06.051","article-title":"Extended-spectrum beta-lactamase (ESBL)-positive Enterobacteriaceae in municipal sewage and their emission to the environment","volume":"128","author":"Korzeniewska","year":"2013","journal-title":"J. Environ. Manag."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.envpol.2017.12.001","article-title":"Metagenomic exploration reveals a marked change in the river resistome and mobilome after treated wastewater discharges","volume":"234","author":"Lekunberri","year":"2018","journal-title":"Environ. Pollut."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"8452","DOI":"10.1038\/ncomms9452","article-title":"Limited dissemination of the wastewater treatment plant core resistome","volume":"6","author":"Munck","year":"2015","journal-title":"Nat. Commun."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1007\/s11356-014-3474-7","article-title":"Antibiotic resistance and prevalence of class 1 and 2 integrons in Escherichia coli isolated from two wastewater treatment plants, and their receiving waters (Gulf of Gdansk, Baltic Sea, Poland)","volume":"22","author":"Kotlarska","year":"2015","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1038\/ismej.2013.189","article-title":"Quantitative and qualitative impact of hospital effluent on dissemination of the integron pool","volume":"8","author":"Stalder","year":"2014","journal-title":"ISME J."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1007\/s00253-009-1886-y","article-title":"Characterization and quantification of class 1 integrons and associated gene cassettes in sewage treatment plants","volume":"82","author":"Zhang","year":"2009","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"An, X.L., Chen, Q.L., Zhu, D., Zhu, Y.G., Gillings, M.R., and Su, J.Q. (2018). Impact of Wastewater Treatment on the Prevalence of Integrons and the Genetic Diversity of Integron Gene Cassettes. Appl. Environ. Microbiol., 84.","DOI":"10.1128\/AEM.02766-17"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1089\/mdr.2016.0329","article-title":"Transmissible Plasmids and Integrons Shift Escherichia coli Population Toward Larger Multiple Drug Resistance Numbers","volume":"24","author":"Suhartono","year":"2018","journal-title":"Microb. Drug Resist."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s00203-004-0726-9","article-title":"Different molecular rearrangements in the integron of the IncP-1 beta resistance plasmid pB10 isolated from a wastewater treatment plant result in elevated beta-lactam resistance levels","volume":"182","author":"Szczepanowski","year":"2004","journal-title":"Arch. Microbiol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"119938","DOI":"10.1016\/j.jenvman.2023.119938","article-title":"Municipal wastewater treatment plant showing a potential reservoir for clinically relevant MDR bacterial strains co-occurrence of ESBL genes and integron-integrase genes","volume":"351","author":"Soni","year":"2024","journal-title":"J. Environ. Manag."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/j.scitotenv.2010.12.011","article-title":"Differential patterns of antimicrobial resistance in population subsets of Escherichia coli isolated from waste- and surface waters","volume":"409","author":"Figueira","year":"2011","journal-title":"Sci. Total Environ."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Abdulkadir, N., Saraiva, J.P., Zhang, J., Stolte, S., Gillor, O., Harms, H., and Rocha, U. (2024). Genome-centric analyses of 165 metagenomes show that mobile genetic elements are crucial for the transmission of antimicrobial resistance genes to pathogens in activated sludge and wastewater. Microbiol. Spectr., 12.","DOI":"10.1128\/spectrum.02918-23"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jes.2017.09.020","article-title":"Amoxicillin effects on functional microbial community and spread of antibiotic resistance genes in amoxicillin manufacture wastewater treatment system","volume":"61","author":"Meng","year":"2017","journal-title":"J. Environ. Sci."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Amirsoleimani, A., Brion, G., and Francois, P. (2021). Co-Carriage of Metal and Antibiotic Resistance Genes in Sewage Associated Staphylococci. Genes, 12.","DOI":"10.3390\/genes12101473"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.scitotenv.2018.05.213","article-title":"Identification of a bacteriophage from an environmental multidrug-resistant E. coli isolate and its function in horizontal transfer of ARGs","volume":"639","author":"Wang","year":"2018","journal-title":"Sci. Total Environ."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/2\/131\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:36:39Z","timestamp":1759919799000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/2\/131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,26]]},"references-count":99,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["antibiotics14020131"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14020131","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,26]]}}}