A review on removing antibiotics and antibiotic resistance genes from wastewater by constructed wetlands: Performance and microbial response

Pollution caused by antibiotics has been highlighted in recent decades as a worldwide environmental and health concern. Compared to traditional physical, chemical and biological treatments, constructed wetlands (CWs) have been suggested to be a cost-efficient and ecological technology for the remediation of various kinds of contaminated waters. In this review, 39 antibiotics removal-related studies conducted on 106 treatment systems from China, Spain, Canada, Portugal, etc. were summarized. Overall, the removal efficiency of CWs for antibiotics showed good performance (average value = over 50%), especially vertical flow constructed wetlands (VFCWs) (average value = 80.44%). The removal efficiencies of sulfonamide and macrolide antibiotics were lower than those of tetracycline and quinolone antibiotics. In addition, the relationship between the removal efficiency of antibiotics and chemical oxygen demand (COD), total suspended solids (TSS), total nitrogen (TN), total phosphorus (TP) and ammonia nitrogen (NH₃-N) concentrations showed an inverted U-shaped curve with turning points of 300 mg L⁻¹, 57.4 mg L⁻¹, 40 mg L⁻¹, 3.2 mg L⁻¹ and 48 mg L⁻¹, respectively. The coexistence of antibiotics with nitrogen and phosphorus slightly reduced the removal efficiency of nitrogen and phosphorus in CWs. The removal effect of horizontal subsurface flow constructed wetlands for antibiotic resistance genes (ARGs) had better performance (over 50%) than that of vertical wetlands, especially for sulfonamide resistance genes. Microorganisms are highly sensitive to antibiotics. In fact, microorganisms are one of the main responsible for antibiotic removal. Moreover, due to the selective pressure induced by antibiotics and drug-resistant gene transfer from resistant bacteria to other sensitive strains through their own genetic transfer elements, decreased microbial diversity and increased resistance in sewage have been consistently reported. This review promotes further research on the removal mechanism of antibiotics and ARGs in CWs.