JMIR Publications

ABSTRACT

Background:

The widespread and unrestricted use of antibiotics has led to the emergence and spread of antimicrobial-resistant bacteria (ARB), antimicrobial-resistant 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 environments.

Objective:

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

Methods:

We will search the Medline, EMBASE, Web of Science, and the World Health Organization Global Index Medicus (WHO GIM) 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 i) presence, concentration, and removal rate of ARB/ARGs going from WWTP influent to effluent, ii) the presence, concentration, and types of antibiotics in the effluent and iii) 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 included studies in a tabular form. The study has been registered in PROSPERO with the registration number: CRD42020212707

Results:

This protocol outlines our proposed methodology for conducting the systematic review.

Conclusions:

We aim to provide an update to the existing literature by searching additional databases. Findings from our study will inform the planning of proper treatment methods that can effectively reduce the level of antibiotic-resistant bacteria, genes, and residual antibiotics in effluent thus lowering the risk of environmental spread of AMR and its further transmission to humans and animals. Clinical Trial: The study was approved by the Ethics Review Board at icddr,b (Protocol Number: PR-20113). The protocol was registered at Prospero and the registration number is CRD42020212707.