Abstract:
Constructed wetlands (CWs) are increasingly promoted as low-cost, nature-based solutions for wastewater
treatment, particularly in low- and middle-income countries (LMICs), yet their performance in removing pharmaceutical compounds, antibiotic resistance genes (ARGs), and bacterial pathogens remains insufficiently
characterized under real-field-scale conditions. Here, we investigated the fate of pharmaceutical compounds
(including antibiotic residues), wastewater bacterial communities, and the associated ARGs in the largest European passive treatment system, the vertical-flow CW of Orhei (Moldova), serving nearly 26,000 inhabitants.
Metagenomic profiling revealed 783 bacterial families, with a reduction from 33 families in raw sewage to 25 in
the final effluent and clear enrichment of autochthonous wetland taxa. A total of 150 ARG types conferring
resistance to 16 antibiotic classes were detected. The cumulative ARG load decreased by approximately 78%
from influent to effluent. ARGs conferring resistance to fosfomycin, nitroimidazoles, rifamycins, streptothricin,
oxazolidinones, and pleuromutilins were not detected in the final effluent, suggesting effective removal to below
the detection limit of the applied metagenomic method, while sulfonamide resistance genes (sul1, sul2) persisted
across all stages. Out of 29 antibiotic residues analyzed, 13 (including two sulfamethoxazole metabolites) were
detected, together with 14 non-antibiotic pharmaceuticals (out of 30 residues analyzed). The removal of individual antibiotics ranged between 85 and 100%, and for other pharmaceuticals between 34 and 100%, although
some compounds (e.g., carbamazepine, 10,11-epoxycarbamazepine, alprazolam) showed negative removals.
Environmental risk assessment (risk quotients, RQ) indicated no significant risk to freshwater biota (RQ < 0.1)
for all detected compounds in the treated effluent. Results demonstrated that a large-scale CW in the LMIC
context can substantially reduce antibiotic residues and ARGs, supporting its role as an effective, nature-based
component of One Health-oriented wastewater management.