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<p>Antimicrobial resistance (AR) is considered a major threat to global public health. Wastewater treatment plants (WWTPs) are among the main reservoirs of antibiotics and AR microbial populations in urban environments, wherein AR can increase due to the optimal conditions provided by biological processes. There is an urgent need to study wastewater medium effects on AR from different standpoints, including the impact of various stressors like heavy metals (HMs). This paper aimed to systematically review, analyze, and discuss the co-existence effects of HMs and AR genes (ARGs) in biologically operated WWTPs. The data were extracted from eligible articles and analyzed using <i>p</i>-values and correlation coefficients (<i>r</i>). Our findings identify a positive correlation between the presence of HMs and ARG copy numbers in 57% (<i>n</i> = 292) of total arrangements (<i>n</i> = 513), of which, 48% (<i>n</i> = 248) were found to be strongly (<i>r</i> &gt; 0.6, <i>p</i> &lt; 0.05) correlated. No correlation was identified between ARGs and HMs in only 11% (<i>n</i> = 55) of the results. Due to insufficient information provided in publications, the other 32% (<i>n</i> = 165) could not be further analyzed. These results are consistent with the potential role of HMs in ARG prevalence in real wastewater. Furthermore, the interactive network of HMs and ARG copy numbers identified the following order of HMs associated with ARGs: Zn &gt; Pb &gt; Cr &gt; Cd=Cu. Together, the findings suggest that HM-rich wastewater may need further attention due to its potential role as a contributing factor of AR.</p>

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Selective pressure beyond antibiotics: heavy metals in wastewater and their role in antimicrobial resistance, a systematic review

  • 期刊论文

  • 发表日期：

    2026年7月8日

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  • Azam Nadali,
  • Troy Skwor,
  • Raheleh Ghouchan Nezhad Noor Nia,
  • Maryam Foroughi

摘要

Antimicrobial resistance (AR) is considered a major threat to global public health. Wastewater treatment plants (WWTPs) are among the main reservoirs of antibiotics and AR microbial populations in urban environments, wherein AR can increase due to the optimal conditions provided by biological processes. There is an urgent need to study wastewater medium effects on AR from different standpoints, including the impact of various stressors like heavy metals (HMs). This paper aimed to systematically review, analyze, and discuss the co-existence effects of HMs and AR genes (ARGs) in biologically operated WWTPs. The data were extracted from eligible articles and analyzed using p-values and correlation coefficients (r). Our findings identify a positive correlation between the presence of HMs and ARG copy numbers in 57% (n = 292) of total arrangements (n = 513), of which, 48% (n = 248) were found to be strongly (r > 0.6, p < 0.05) correlated. No correlation was identified between ARGs and HMs in only 11% (n = 55) of the results. Due to insufficient information provided in publications, the other 32% (n = 165) could not be further analyzed. These results are consistent with the potential role of HMs in ARG prevalence in real wastewater. Furthermore, the interactive network of HMs and ARG copy numbers identified the following order of HMs associated with ARGs: Zn > Pb > Cr > Cd=Cu. Together, the findings suggest that HM-rich wastewater may need further attention due to its potential role as a contributing factor of AR.