Resistance Mechanisms and Dissemination of Resistance Genes in Gram-negative Bacteria from Wastewater Treatment Systems: Environmental Risk
Keywords:
Antimicrobial resistance, Gram negative bacteria, Wastewater treatment, Resistance mechanisms, Environmental disseminationAbstract
Antimicrobial resistance (AMR) is a global public health threat, particularly among Gram-negative bacteria that possess multiple resistance mechanisms, including enzymatic degradation, target modification, and antibiotic efflux. Wastewater treatment systems receiving discharges from hospitals, pharmaceutical industries, and community wastewater are recognized as major hotspots for the accumulation and dissemination of antibiotic-resistant bacteria (ARB) and resistance genes (ARGs) through horizontal gene transfer (HGT). This narrative review summarizes current knowledge on bacterial resistance mechanisms, environmental dissemination pathways, and recent technologies for AMR mitigation in wastewater systems. Evidence indicates that conventional treatment processes cannot completely remove resistance genes, highlighting the need for advanced disinfection methods such as ultraviolet irradiation, ozonation, and advanced oxidation processes. Strengthening source control by limiting the discharge of antibiotics and heavy metals and adopting the “One Health” framework that integrates human, animal, and environmental health are essential for effective and sustainable AMR management.
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