Effective Treatment Strategies for the Removal of Antibiotic-Resistant Bacteria, Antibiotic-Resistance Genes, and Antibiotic Residues in the Effluent From Wastewater Treatment Plants Receiving Municipal, Hospital, and Domestic Wastewater: Protocol for a Systematic Review

Mahbub-Ul Alam; Sharika Ferdous; Ayse Ercumen; Audrie Lin; Abul Kamal; Sharmin Khan Luies; Fazle Sharior; Rizwana Khan; Md Ziaur Rahman; Sarker Masud Parvez; Nuhu Amin; Birkneh Tilahun Tadesse; Niharu Akter Moushomi; Rezaul Hasan; Neelam Taneja; Mohammad Aminul Islam; Mahbubur Rahman

doi:10.2196/33365

Effective Treatment Strategies for the Removal of Antibiotic-Resistant Bacteria, Antibiotic-Resistance Genes, and Antibiotic Residues in the Effluent From Wastewater Treatment Plants Receiving Municipal, Hospital, and Domestic Wastewater: Protocol for a Systematic Review

JMIR Res Protoc. 2021 Nov 26;10(11):e33365. doi: 10.2196/33365.

Authors

Mahbub-Ul Alam¹, Sharika Ferdous¹, Ayse Ercumen², Audrie Lin³, Abul Kamal¹, Sharmin Khan Luies¹, Fazle Sharior¹, Rizwana Khan¹, Md Ziaur Rahman¹, Sarker Masud Parvez¹, Nuhu Amin¹, Birkneh Tilahun Tadesse⁴, Niharu Akter Moushomi¹, Rezaul Hasan¹, Neelam Taneja⁵, Mohammad Aminul Islam⁶, Mahbubur Rahman¹

Affiliations

¹ Environmental Interventions Unit, Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh.
² North Carolina State University, North Carolina, NC, United States.
³ University of California Berkeley, Berkeley, CA, United States.
⁴ Hawassa University, Awassa, Ethiopia.
⁵ Postgraduate Institute of Medical Education and Research, Chandigarh, India.
⁶ Washington State University, Washington, WA, United States.

PMID: 34842550
PMCID: PMC8665387
DOI: 10.2196/33365

Abstract

Background: The widespread and unrestricted use of antibiotics has led to the emergence and spread of antibiotic-resistant bacteria (ARB), antibiotic-resistance genes (ARGs), and antibiotic residues in the environment. Conventional wastewater treatment plants (WWTPs) are not designed for effective and adequate removal of ARB, ARGs, and antibiotic residues, and therefore, they play an important role in the dissemination of antimicrobial resistance (AMR) in the natural environment.

Objective: We will conduct a systematic review to determine the most effective treatment strategies for the removal of ARB, ARGs, and antibiotic residues from the treated effluent disposed into the environment from WWTPs that receive municipal, hospital, and domestic discharge.

Methods: We will search the MEDLINE, EMBASE, Web of Science, World Health Organization Global Index Medicus, and ProQuest Environmental Science Collection databases for full-text peer-reviewed journal articles published between January 2001 and December 2020. We will select only articles published in the English language. We will include studies that measured (1) the presence, concentration, and removal rate of ARB/ARGs going from WWTP influent to effluent, (2) the presence, concentration, and types of antibiotics in the effluent, and (3) the possible selection of ARB in the effluent after undergoing treatment processes in WWTPs. At least two independent reviewers will extract data and perform risk of bias assessment. An acceptable or narrative synthesis method will be followed to synthesize the data and present descriptive characteristics of the included studies in a tabular form. The study has been approved by the Ethics Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh (protocol number: PR-20113).

Results: This protocol outlines our proposed methodology for conducting a systematic review. Our results will provide an update to the existing literature by searching additional databases.

Conclusions: Findings from our systematic review will inform the planning of proper treatment methods that can effectively reduce the levels of ARB, ARGs, and residual antibiotics in effluent, thus lowering the risk of the environmental spread of AMR and its further transmission to humans and animals.

International registered report identifier (irrid): PRR1-10.2196/33365.

Keywords: antibiotic residues; antibiotic-resistance genes; antibiotic-resistant bacteria; antibiotics; antimicrobial resistance; antimicrobial-resistance genes; antimicrobial-resistant bacteria; effluent; systematic review; wastewater treatment plant.

©Mahbub-Ul Alam, Sharika Ferdous, Ayse Ercumen, Audrie Lin, Abul Kamal, Sharmin Khan Luies, Fazle Sharior, Rizwana Khan, Md Ziaur Rahman, Sarker Masud Parvez, Nuhu Amin, Birkneh Tilahun Tadesse, Niharu Akter Moushomi, Rezaul Hasan, Neelam Taneja, Mohammad Aminul Islam, Mahbubur Rahman. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 26.11.2021.