Antimicrobial resistance (AMR) is a naturally-arising evolutionary phenomenon whereby micro-organisms develop the ability to tolerate compounds which would usually kill them or inhibit their growth.1,2 Infections by bacteria resistant to clinical antibiotics were directly responsible for 1.27 million deaths per year globally as of 2019, and associated with 4.95 million deaths.3 According to the projections of a report commissioned by the UK Government, up to 10,000,000 people annually could die from resistant infections globally by 2050, with a cumulative economic loss of 100 trillion USD if nothing is done to curb AMR.4 The World Health Organisation considers preventative measures of controlling AMR, such as hygiene, vaccination, and sanitation (wastewater and sewage treatment) equally as important as antibiotic drug development–if not more so.5 Therefore, creative, non-therapeutic solutions upstream of the clinic are urgently needed.6
The work herein demonstrates the development of non-pharmaceutical AMR mitigation solutions in a sustainable manner through the pyrolysis of waste lignocellulosic biomass (LCB). Pyrolysing agricultural waste biomass yields appropriate materials for effective in-line filters that sequester multi-drug-resistant (MDR) bacteria, as well as active pharmaceutical ingredients (APIs), from medical and pharmaceutical wastewater. This both reduces the prevalence of AMR genes/organisms in the environment, and drives down the concentration of selective and co-selective pharmapollutants in wastewater. Such upstream solutions are critical to curtail the prevalence of AMR in the environment, and reduce the number of resistant infections globally.
The emergence of AMR in the environment poses the most substantial AMR-related health and safety risk for humans aside from clinical and agricultural use of antimicrobials.7 The overuse and misuse of clinical antimicrobials is one of the most prominent drivers of AMR, and is actively being addressed through a number of local, national, and global antimicrobial stewardship efforts.8–10 However, an oft-neglected driver/reservoir of AMR is the environment, in which wastewater is one major source. According to the World Water Assessment Programme (United Nations)11, 80% of wastewater is discharged into the environment untreated each year. In England, there are approximately 15,000 sewage overflow (SO) points across the country, of which 89% directly discharge into freshwater bodies.12 During 2023, there were 464,056 spill events from all monitored SOs in England and Wales, amounting to 3,606,170 hours of discharge in a single calendar year.13 This has resulted in measurable concentrations of several antibiotics in British rivers for many years. 14
Key measurements of antimicrobial resistance in the environment include the prevalence of antimicrobial molecules in air, water, and soil (antimicrobial pollution); the prevalence of antimicrobial-resistant bacteria (“ARBs”); and the associated prevalence of antimicrobial resistance genes (“ARGs”). Wastewater effluents from hospitals and pharmaceutical production/manufacturing plants can be particularly large contributors to all of these metrics.15–19 Hospital effluent is a major source of resistant pathogens and both are substantial sources of antimicrobial pollution, which contributes to the selective pressures in the environment and further develops AMR.20 Proper treatment of wastewater (particularly those from hospitals and the pharmaceutical industry) has been identified as a key strategy to helping prevent the spread of AMR.21–25
Current wastewater treatment plant (WWTP) technologies alone are inadequate for reducing environmental AMR, even during optimal operation and when not engaging in “bypass” (the release of untreated sewage into the environment).26 WWTPs are known contributors to environmental AMR, as they allow flows from various sources to mix, creating a “hotspot” for horizontal gene transfer between resistant and non-resistant bacteria.27,28 Even when they are successful in reducing absolute bacterial loads, WWTPs can select for the most resistant bacteria.18 Likewise, WWTPs do not effectively remove antimicrobial compounds from the waste stream.29–31 In the River Wandle, located in the southeast of London, the antibiotics azithromycin, clarithromycin, sulfamethoxazole, and sulphapyridine were present at concentrations ranging from 132 ng/L to 476 ng/L directly downstream of the outfall from the local WWTP.32
A potential solution to this problem is the filtration of clinical and pharmaceutical wastewater prior to its arrival at WWTPs. Such in-line filters would remove bacteria and antimicrobials upstream of WWTPs. This would have two benefits: preventing horizontal AMR gene transfer at WWTPs, which act as key interfaces between non-resistant and resistant bacteria;33 and reducing total prevalence of ARGs and ARBs in WWTPs, so that fewer are released into the environment during a CSO or bypass event. To minimise environmental impact from manufacture and promote sustainable practices, these filters should be produced from waste materials using mild process conditions, as is the case for waste lignocellulosic biochars. Filters installed in e.g. sink traps, shower drains, or batch-production waste lines additionally benefit from repeated wet-dry cycles, which have been shown to augment the bacterial-retention capacity of biochars.34 However, it is important to consider the possibility of developing resistance within such filters. While the mechanisms of resistance to adsorption itself would not be expected to drive cross-resistance to clinical antimicrobials, exposure to APIs in close proximity might. Therefore, it is critical to consider how spent filters, bearing a substantial load of hazardous substances, might be safely be treated to enable safe disposal and/or reuse. One possibility is re-pyrolysis, i.e. renewed exposure of the filter to heat without addition of an oxidising atmosphere. During this process, the elevated temperature would be expected to kill adsorbed microorganisms and degrade adsorbed APIs. This would also increase the surface area available for adsorption, which may have diminished as a result of extended use.
Biochars are the thermal or thermochemical decomposition products of LCB. LCB is the largest stream of non-edible biomass globally, the primary sources of which are agricultural and forestry waste streams.35 This work focuses on walnut shells, a food systems by-product with a high surface area cell structure.36 While LCB is naturally porous, pyrolysis and gasification have been shown to vastly increase its porosity,37–41 and therefore the surface area available for adsorption. Biochars are widely used for a variety of adsorption-dependent environmental remediation applications including air, water, and soil treatment.42
With respect to bacteria, biochars are most commonly used for soil bioremediation using bacteria-impregnated,43–46 or virgin biochars.43,47–53 Far fewer studies have investigated the ability of biochars to sequester bacteria or APIs for the treatment of wastewater. Previous studies on bacterial adsorption have largely used biochars as additives to conventional wastewater filters,34,54,55 or to soil.48,50,51 A few have tested bacterial adsorption directly in liquid medium using a batch process,48,56 but none have tested the ability of biochars alone to adsorb and retain bacteria in-line, as would be the case in sink trap/shower drain filters. The primary shortcoming of previous studies of bacterial adsorption has been the lack of control over pyrolysis conditions. Existing studies of bacterial adsorption using biochars either do not specify key pyrolysis process conditions, such as atmosphere, peak temperature, heating rate, or residence time at peak temperature,48,50,54,56 or specify broad ranges of these values, implying highly heterogeneous samples.34,50,51,55 In addition, none of these studies specify more sophisticated process conditions, such as gas flowrate, detailed reactor design, or sample size & configuration. Reactor design and process parameters in biomass pyrolysis experiments have been shown to dramatically affect pyrolysis outcomes.57 There have been some attempts to link pyrolysis peak temperature to bacterial adsorption properties,50,51,54 but without reactor and experimental design allowing for the repeatable production of homogeneous biochar samples, the reliability of these results is inconclusive.
Another shortcoming of existing studies is the use of non-clinically-relevant strains of bacteria. Only one of the aforementioned studies (Naka et al. 56) tested adsorption of human pathogens (E. coli O157:H7); This study used “commercially-obtained activated charcoal” for which no production conditions were specified. No existing publications report testing those species most often associated with antibiotic resistance (“ESKAPE pathogens”),58 or any species on the WHO’s “bacterial priority pathogens list” such as drug-resistant Pseudomonas aeruginosa or Staphylococcus aureus.59
The removal of APIs from waste streams using biochar adsorbents is an attractive strategy due to the cost-effective and sustainable nature of the product compared to existing solutions.60,61 Antibiotic removal using biochar in particular has been extensively characterised in the literature, with some studies reporting almost 100% removal of compounds using a variety of biochar feedstocks.62,63 However, most studies have characterised the adsorption of APIs from synthetic wastewater or other aqueous matrices64 at concentrations over 20-fold greater than what is typically observed in influent wastewater (less than 700 ng/L).65 This is not necessarily representative of the complexity of a true wastewater matrix and the concentrations of APIs present in real-world samples that may affect adsorption.
This study presents an optimised workflow for accurately testing the effects of pyrolysis conditions and resulting biochar morphologies on bacterial and API adsorption performance. The primary objective of this work was to determine the optimal biochar production conditions for the removal of Gram-negative and Gram-positive critical and high-priority ESKAPE pathogens and APIs from a wastewater matrix. Biochar morphologies were characterised using a synchrotron X-ray microtomography and in-situ radiography, as described in previous work.37 This work demonstrates that the in-line sequestration of APIs and clinical strains of resistant pathogens using biochars produced from walnut shells is feasible, and that morphology & adsorption performance of these biochars may be tailored by choice of production conditions.