The Complex Interplay Between Antibiotic Resistance and Pharmaceutical and Personal Care Products in the Environment

Antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) are important environmental contaminants. Nonetheless, what drives the evolution, spread, and transmission of antibiotic resistance dissemination is still poorly understood. The abundance of ARB and ARGs is often elevated in human-impacted areas, especially in environments receiving fecal wastes, or in the presence of complex mixtures of chemical contaminants, such as pharmaceuticals and personal care products. Self-replication, mutation, horizontal gene transfer, and adaptation to different environmental conditions contribute to the persistence and proliferation of ARB in habitats under strong anthropogenic influence. Our review discusses the interplay between chemical contaminants and ARB and their respective genes, specifically in reference to co-occurrence, potential biostimulation, and selective pressure effects, and gives an overview of mitigation by existing man-made and natural barriers. Evidence and strategies to improve the assessment of human health risks due to environmental antibiotic resistance are also discussed. Environ Toxicol Chem 2023;00:1-16. (c) 2022 SETAC

Automated summary

Antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) are prevalent environmental contaminants. Factors driving the evolution and dissemination of antibiotic resistance are not well understood. ARB and ARGs are often found in areas impacted by human activity, particularly in environments affected by fecal wastes or mixed chemical contaminants. Our review explores the relationship between chemical contaminants and ARB/ARGs, including co-occurrence, potential biostimulation, selective pressure effects, and mitigation strategies. We also discuss evidence and strategies for assessing human health risks associated with environmental antibiotic resistance.