{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:58:51Z","timestamp":1792807131031,"version":"4.5.0"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T00:00:00Z","timestamp":1693180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Government of the United Kingdom of Great Britain and Northern Ireland, represented by its Department of Health and Social Care (DHSC)","award":["AMR HQTDR 2220608"],"award-info":[{"award-number":["AMR HQTDR 2220608"]}],"id":[{"id":"https:\/\/ror.org\/03sbpja79","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Wastewater treatment plants are efficient in reducing bacterial loads but are also considered potential drivers of environmental antimicrobial resistance (AMR). In this study, we determined the effect of increased influent wastewater volume (from 40% to 66%) in the Legon sewage treatment plant (STP) on the removal of E. coli from sewage, along with changes in AMR profiles. This before and after study compared E. coli loads and AMR patterns in influent and effluent samples from a published baseline study (January\u2013June 2018) with a follow-up study (March\u2013May 2023). Extended-spectrum beta-lactamase (ESBL) E. coli were measured pre- and post-sewage treatment during the follow-up study. The follow-up study showed 7.4% and 24% ESBL E. coli proportions in influent and effluent, respectively. In both studies, the STP was 99% efficient in reducing E. coli loads in effluents, with no significant difference (p = 0.42) between the two periods. More E. coli resistance to antimicrobials was seen in effluents in the follow-up study versus the baseline study. The increased influent capacity did not reduce the efficiency of the STP in removing E. coli from influent wastewater but was associated with increased AMR patterns in effluent water. Further studies are required to determine whether these changes have significant effects on human health.<\/jats:p>","DOI":"10.3390\/tropicalmed8090427","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T10:49:10Z","timestamp":1693306150000},"page":"427","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Assessing Changes in Bacterial Load and Antibiotic Resistance in the Legon Sewage Treatment Plant between 2018 and 2023 in Accra, Ghana"],"prefix":"10.3390","volume":"8","author":[{"given":"Raymond Lovelace","family":"Adjei","sequence":"first","affiliation":[{"name":"Council for Scientific and Industrial Research\u2014Animal Research Institute, Accra P.O. Box AH 20, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9478-0057","authenticated-orcid":false,"given":"Lady Asantewah Boamah","family":"Adomako","sequence":"additional","affiliation":[{"name":"Council for Scientific and Industrial Research\u2014Water Research Institute, Accra P.O. Box AH 38, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Appiah","family":"Korang-Labi","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franklin Kodzo","family":"Avornyo","sequence":"additional","affiliation":[{"name":"Council for Scientific and Industrial Research\u2014Animal Research Institute, Accra P.O. Box AH 20, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collins","family":"Timire","sequence":"additional","affiliation":[{"name":"International Union against Tuberculosis and Lung Disease (The Union), 2 Rue Jean Lantier, 75001 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9568-9434","authenticated-orcid":false,"given":"Rita Ohene","family":"Larbi","sequence":"additional","affiliation":[{"name":"Council for Scientific and Industrial Research\u2014Animal Research Institute, Accra P.O. Box AH 20, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cletus","family":"Kubasari","sequence":"additional","affiliation":[{"name":"Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, Kintampo P.O. Box 200, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen E. D.","family":"Ackon","sequence":"additional","affiliation":[{"name":"Accra Sewerage Improvement Project, Accra Metro Sewerage Unit, Ministries, Accra P.O. Box MB 201, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Reid","sequence":"additional","affiliation":[{"name":"Operational Research Unit (LuxOR), Medical Department, M\u00e9decins Sans Fronti\u00e8res Operational Centre, 1050 Bruxelles, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,28]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Tackling AMR from a multidisciplinary perspective: A primer from education and psychology","volume":"26","author":"Carrilero","year":"2023","journal-title":"Int. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"278","DOI":"10.3390\/ijerph10010278","article-title":"Transfer of multidrug-resistant bacteria between intermingled ecological niches: The interface between humans, animals and the environment","volume":"10","author":"Loureiro","year":"2013","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Serweci\u0144ska, L. (2020). Antimicrobials and antibiotic-resistant bacteria: A risk to the environment and to public health. Water, 12.","DOI":"10.3390\/w12123313"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/B978-0-12-818882-8.00016-4","article-title":"Toxicity of antibiotics","volume":"Volume 1","author":"Rehman","year":"2020","journal-title":"Antibiotics and Antimicrobial Resistance Genes in the Environment"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gwenzi, W., Simbanegavi, T.T., and Rzymski, P. (2023). Household disposal of pharmaceuticals in low-income settings: Practices, health hazards, and research needs. Water, 15.","DOI":"10.3390\/w15030476"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1002\/mbo3.319","article-title":"Identification and antimicrobial resistance prevalence of pathogenic Escherichia coli strains from treated wastewater effluents in Eastern Cape, South Africa","volume":"5","author":"Adefisoye","year":"2016","journal-title":"Microbiologyopen"},{"key":"ref_7","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_8","doi-asserted-by":"crossref","unstructured":"Fouz, N., Pangesti, K.N., Yasir, M., Al-Malki, A.L., Azhar, E.I., Hill-Cawthorne, G.A., and Abd El Ghany, M. (2020). The contribution of wastewater to the transmission of antimicrobial resistance in the environment: Implications of mass gathering settings. Trop. Med. Infect. Dis., 5.","DOI":"10.3390\/tropicalmed5010033"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Watts, J.E.M., Schreier, H.J., Lanska, L., and Hale, M.S. (2017). The rising tide of antimicrobial resistance in aquaculture: Sources, sinks and solutions. Mar. Drugs, 15.","DOI":"10.3390\/md15060158"},{"key":"ref_10","unstructured":"Karkman, A., Do, T.T., Walsh, F., and Virta, M.P.J. (2023, June 05). Antibiotic Resistance Genes in Waste Water. Available online: http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Antwi-Agyei, P., Dwumfour-Asare, B., Adjei, K.A., Kweyu, R., and Simiyu, S. (2020). Understanding the barriers and opportunities for effective management of shared sanitation in low-income settlements\u2014The case of Kumasi, Ghana. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17124528"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1007\/s13157-021-01510-w","article-title":"Pollution or protection-what early survey data shows on rapid waterbird utilisation of a newly established sewage treatment plant in urban Ghana, West Africa?","volume":"41","author":"Holbech","year":"2021","journal-title":"Wetlands"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e02505","DOI":"10.1016\/j.heliyon.2019.e02505","article-title":"GIS-aided optimisation of faecal sludge management in developing countries: The case of the Greater Accra Metropolitan Area, Ghana","volume":"5","author":"Sagoe","year":"2019","journal-title":"Heliyon"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Adomako, L.A.B., Yirenya-Tawiah, D., Nukpezah, D., Abrahamya, A., Labi, A.-K., Grigoryan, R., Ahmed, H., Owusu-Danquah, J., Annang, T.Y., and Banu, R.A. (2021). Reduced bacterial counts from a sewage treatment plant but increased counts and antibiotic resistance in the recipient stream in Accra, Ghana\u2014A cross-sectional study. Trop. Med. Infect. Dis., 6.","DOI":"10.3390\/tropicalmed6020079"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"106702","DOI":"10.1016\/j.ecoleng.2022.106702","article-title":"Numerical modelling of hydraulic efficiency and pollution transport in waste stabilization ponds","volume":"182","author":"Goodarzi","year":"2022","journal-title":"Ecol. Eng."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"899","DOI":"10.2166\/wh.2020.014","article-title":"Prevalence of ESBL-producing Escherichia coli and carbapenem-resistant enterobacteriaceae in treated wastewater: A comparison with nosocomial infection surveillance","volume":"18","author":"Urase","year":"2020","journal-title":"J. Water Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.ejpe.2016.10.004","article-title":"Feasibility study for biogas integration into waste treatment plants in Ghana","volume":"26","author":"Mohammed","year":"2017","journal-title":"Egypt. J. Pet."},{"key":"ref_18","unstructured":"(2005). Water Quality\u2014General Guidance on the Enumeration of Micro-Organisms by Culture, p. 38 (Standard No. ISO 8199:2005). Available online: https:\/\/www.iso.org\/standard\/37011.html."},{"key":"ref_19","unstructured":"Weinstein, M.P. (2023). Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing, Clinical and Laboratory Standards Institute."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"121934","DOI":"10.1016\/j.biortech.2019.121934","article-title":"Microalgae-based wastewater treatment for nutrients recovery: A review","volume":"291","author":"Li","year":"2019","journal-title":"Bioresour. Technol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"106436","DOI":"10.1016\/j.envint.2021.106436","article-title":"Evidence for selection of multi-resistant E. coli by hospital effluent","volume":"150","author":"Kraupner","year":"2021","journal-title":"Environ. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"105551","DOI":"10.1016\/j.envint.2020.105551","article-title":"Distribution, combined pollution and risk assessment of antibiotics in typical marine aquaculture farms surrounding the Yellow Sea, North China","volume":"138","author":"Han","year":"2020","journal-title":"Environ. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"106809","DOI":"10.1016\/j.foodcont.2019.106809","article-title":"Addressing the antibiotic resistance and improving the food safety in food supply chain (farm-to-fork) in Southeast Asia","volume":"108","author":"Thapa","year":"2020","journal-title":"Food Control."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"156232","DOI":"10.1016\/j.scitotenv.2022.156232","article-title":"Distribution and characteristics of carbapenem-resistant and extended-spectrum \u03b2-lactamase 1 (ESBL) producing Escherichia coli in hospital effluents, sewage treatment plants, and river 2 water in an urban area of Japan","volume":"839","author":"Azuma","year":"2022","journal-title":"Sci. Total Environ."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"134023","DOI":"10.1016\/j.scitotenv.2019.134023","article-title":"Antibiotic resistance genes identified in wastewater treatment plant systems\u2014A review","volume":"697","author":"Pazda","year":"2019","journal-title":"Sci. Total Environ."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S1473-3099(12)70317-1","article-title":"The role of the natural environment in the emergence of antibiotic resistance in Gram-negative bacteria","volume":"13","author":"Wellington","year":"2013","journal-title":"Lancet Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e2226822","DOI":"10.1001\/jamanetworkopen.2022.26822","article-title":"Association of SARS-CoV-2 load in wastewater with reported COVID-19 cases in the Tokyo 2020 Olympic and paralympic village from July to September 2021","volume":"5","author":"Kitajima","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_28","first-page":"44","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"101026","DOI":"10.1016\/j.eti.2020.101026","article-title":"Removal of pesticides from water and wastewater: Chemical, physical and biological treatment approaches","volume":"19","author":"Saleh","year":"2020","journal-title":"Environ. Technol. Innov."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"125482","DOI":"10.1016\/j.cej.2020.125482","article-title":"Comparison of UV, UV\/H2O2 and ozonation processes for the treatment of membrane distillation concentrate from surface water treatment: PhACs removal and environmental and human health risk assessment","volume":"397","author":"Alvim","year":"2020","journal-title":"Chem. Eng. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"012002","DOI":"10.1088\/1742-6596\/1456\/1\/012002","article-title":"Laboratory scale ozone-based post-treatment from textile wastewater treatment plant effluent for water reuse","volume":"1456","author":"Suryawan","year":"2020","journal-title":"J. Phys. Conf. 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