Environmental Antibiotic Resistance in Resource-Limited Settings: Sources, Mechanisms and Sustainable Mitigation Strategies; A Review
Keywords:
Antibiotic resistance genes , wastewater, horizontal gene transfer, resistome, co-selection, nature-based treatmentAbstract
Antibiotic resistance has grown to be a major global health concern, and environmental systems are being recognized as significant reservoirs and transmission pathways for antibiotic-resistance genes (ARGs). In particular, resistant bacteria, mobile genetic elements, and co-selective pollutants congregate in wastewater systems, which promotes the persistence and spread of resistance. Recent studies on the existence, diffusion mechanisms, and co-selection of ARGs in wastewater systems, both globally and in Pakistan, are compiled in this review. The role of non-antibiotic contaminants in resistance maintenance, horizontal gene transfer channels, and methodological differences between DNA-based resistome methods and culture-based surveillance are highlighted. Additionally, the effectiveness of both new, low-cost, nature-based mitigation techniques and traditional treatment methods is critically assessed. The evidence examined indicates that while conventional disinfection can reduce ARG loads to some degree, its effectiveness varies and is occasionally insufficient in practical situations. However, nature-based and hybrid treatment approaches show promising elimination efficiency and practical in resource-constrained environments such as Pakistan. Quantitative modeling of ARG elimination, reliable monitoring systems, and long-term field-scale validation of mitigating devices are still severely constrained. This research highlights the need for comprehensive, One-Health-oriented surveillance and the creation of predictive and economical treatment options to successfully manage antibiotic resistance in wastewater systems.
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