Introduction

Abbreviations and symbols used in this review are summarized in Table 1. The term microplastics (MPs) usually refer to small particles less than 5.0 mm in diameter, which degrade into smaller diameter particles, or even nanoparticles (NPs). Plastics are destroyed under physical, chemical, biological, and other actions, resulting in MPs1. This concept was proposed in 2004, and MPs are becoming increasingly common environmental pollutants worldwide2. Wastewater treatment plants (WWTPs) have proven to be the primary way in which MPs are released into aquatic environments. For example, residues such as toothpaste, detergent and shower gel end up in rivers and lakes3. Plastic waste accumulates in the environment due to its resistance to degradation and low recycling efficiency. High hydrophobicity and a large specific surface area are characteristics of MPs. They enrich, transports, and concentrate organic pollutants, metals, and microorganisms. Antibiotics are of significant concern among all organic pollutants, because they can induce the emergence, spread, and enrichment of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs). Since their discovery, antibiotics have been actively employed in human activities, such as agriculture, aquaculture, animal husbandry, and the treatment or prevention of infectious diseases4,5. Moreover, antibiotics are not easily removed; residual antibiotics are continuously released into surface water6, groundwater, or sediments. Additionally, antibiotics are a major public health problem associated with antibiotic-resistant microorganisms7,8,9. MPs and antibiotics end up in WWTPs through municipal pipe networks, so WWTPs are considered their reservoirs10. In addition, MPs facilitate the spread of antibiotic resistance-related bacteria such as ARGs via horizontal gene transfer (HGT)11,12, improving the ability of ARGs to spread between bacteria13.

Table 1 Abbreviation used in this paper.

Although there are many reports of MPs, antibiotics, and ARGs, the current reports mainly focus on the effect of MPs on ARGs enrichment and release and environmental migration in water or soil media, and ecotoxicological studies of aquatic or terrestrial animals and plants14,15,16. Studies have found that MPs not only slow down the rate of antibiotic degradation, but also accelerate the enrichment of ARGs17,18. Biofilms formed by MPs provide an ideal environment for the growth and prevalence of drug-resistant bacteria19,20, although some progress has been made in the study of the eliminatory mechanisms of antibiotic-resistant bacteria (ARB) and ARGs21. However, the research on MPs and ARGs in WWTPs is lacking. WWTPs serve as reservoirs for these contaminants, and the complex mechanisms of interaction between them should be systematically explored. This article links them together for the first time, reviewing the sources and trends of MPs, antibiotics, and ARGs in WWTPs and their mechanisms of interaction. Their impacts on the processing performance of WWTPs are also analyzed. Furthermore, this article also reveals the harm inflicted by MPs and ARGs on the environment and human body.

Results

Study analysis of the sources of MPs, antibiotics and ARGs

Plastics offer the advantages of being inexpensive, light, durable, and easy to carry and have been widely used in various fields. The global plastics manufacturing industry has grown rapidly since the 1960s22. Global plastic production soared from 1.5 million tonnes in 1950 to 368.0 million tonnes in 2019. At present, plastic production equates to 360.0 million tons per year, and it is expected to reach 33.0 billion tons by 205023. However, the recycling rate of plastics is extremely low, with only 9.0% of plastic waste being globally recycled in 201924. The main sources of MPs are shown in Fig. 1. MPs can be transported directly from cosmetics, personal care products, and polyester into the environment through washing and other processes. The irrational use of plastic products in agriculture has also generated significant important environmental pollution problems25,26. Because plastic materials are difficult to degrade, they can accumulate in aquatic environments and persist for years to decades27; therefore, MPs are persistent pollutants28. According to the size of the plastic fragments, plastics can be divided into NPs (< 0.001 mm), MPs (≥ 0.001 mm and < 5.0 mm), medium plastics (≥ 5.0 mm and < 25.0 mm) and large plastics (≥ 25.0 mm)29. Plastic granules are made up of polymers with many different components, densities and shapes30. It has been reported that MPs have been found in living organisms, and MPs may cause oxidative stress and adsorb pollutants such as heavy metals or organic matter31. MPs have been recognized as “emerging pollutants”32. Table 1 shows the abbreviations for MPs.

Figure 1
figure 1

Pathways for microplastics to wastewater treatment plant. The solid black and red dotted lines represent the primary and secondary sources of microplasticity, respectively. (Adapted with permission from Ref.33).

Since the discovery of penicillin in 1928, antibiotics have been fully integrated into people's daily lives34. Antibiotics are commonly used in human and veterinary medicine35, and an increasing number of antibiotics are being detected in aquatic environments36. From 2000 to 2010, the use of antibiotics in clinical, agricultural, food, and aquaculture settings increased by 35.0% globally, with countries such as Brazil, Russia, India, China and South Africa consuming 79.0% of the world's antibiotics37. Between 2010 and 2030, global consumption of antimicrobials is expected to grow from 63,151.0 to 105,596.0 tonnes38. However, antibiotics cannot be completely metabolized in an organism39; this means that antibiotics are released into the environment, and accumulated antibiotics have biological effects40. Antibiotics can be considered “pseudo-persistent” organic pollutants41. Antibiotics eventually enter WWTPs via the municipal pipe networks (Fig. 2). However traditional WWTPs have more difficultly degrading antibiotics, mainly because the main purpose of traditional WWTPs is to remove pollutants that are easily biodegradable. Figure 3 shows the concentration distribution and removal rates of 4 different types of antibiotics in WWTPs. Antibiotics have a negative effect on microorganisms in biochemical processes: they hinder cell wall construction, and inhibit protein production, interfere with cell membrane function42. Notably, the widespread and injudicious usage of antibiotics to contain pathogenic microbial infections, coupled with inadequate treatment of wastes containing non-metabolized antibiotics and their residues lead to an increase in antibiotic concentrations in the environment, leading to antibiotic contamination.

Figure 2
figure 2

Sources of antibiotics in wastewater treatment plant and water environments. (Adapted with permission from Ref.43).

Figure 3
figure 3

Concentration distribution of different types of antibiotics in sewerage system (a) Sulfonamides, (b) Tetracyclines, (c) Quinolones and (d) Macrolides (Box plots show 25th and 75th percentile (box), median lines show the median values, and whiskers correspond to minimum and maximum values. The spheres represent concentration values. (e) Elimination of total antibiotic concentration throughout sewerage system. (Adapted with permission from Ref.44).

The extensive use of antibiotics promotes the production of ARGs45. Untreated municipal sewage or substandard wastewater from WWTPs can release large amounts of antibiotics into the environment. A large number of microorganisms are exposed to residual antibiotics during wastewater transportation and treatment, inducing the production and enrichment of ARGs46. There are two ways for bacteria to acquire ARGs; through their own genetic mutations that lead to the production of ARGs or via HGT acquisition. Figure 4 presents the main HGT mechanisms (coupling, natural transformation, and transduction)47. In the former, ARGs are mainly passed on to offspring through vertical gene transfer (VGT), while in the latter, ARG spreads faster allowing them to spread more widely and be passed between different bacteria and even different species48. The environment of WWTPs is suitable for HGT, and its emissions are a potential hotspot for the development of antibiotic resistance49. WWTPs are not only gathering places for drug-resistant organisms and antimicrobial agents from various sources but also potential sources of ARGs. ARGs are discharged into natural water bodies through WWTP wastewater, which is the main pathway for local bacteria to develop antibiotic resistance.

Figure 4
figure 4

The main horizontal gene transfer mechanisms via conjugation, natural transformation and transduction. (Adapted with permission from Ref.50).

The fate of MPs, antibiotics and ARGs

The primary treatments employed in WWTPs easily remove bulky particles, floating or suspended solids, and gravel27. Primary precipitation is the main process through which MPs are removed in primary treatment, but its ability of removing MPs from wastewater is not good. Initial treatment can only remove 35.0–59.0% of MPs from wastewater51. Secondary treatment in WWTPs involves biological processes and physical phase separation. Commonly used secondary treatment processes in WWTPs are the activated sludge (AS) process and the use of drip filters and rotary biological contactors52, allowing the concentration of MPs in wastewater to be reduced by another 0.2–14.0%. The removal mechanism in the secondary treatment process is AS or a bacterial extracellular polymer that uses dissolved oxygen to promote the growth of biological flocs53; This helps MPs accumulate in the sludge. During secondary treatment, the concentration of MPs with a particle size of 100.0–300.0 μm decreases, and 20.0–100.0 μm MPs accounts for 80.0% of the total removed MPs54. It is difficult to detect MPs larger than 500.0 μm in wastewater after secondary treatment. All advanced tertiary treatment stage technologies can remove more than 95.0% of MPs with particle sizes greater than 20.0 μm. Membrane bio-reactors (MBRs) have the highest removal efficiency, although they may capture more than 90.0% in wastewater, but most of the MPs in WWTPs end up remaining in the sludge, and the retention rate of MPs may reach 99.0%. It is estimated that the concentration of MPs in waste sludge ranges from 1.5 × 103 to 2.4 × 104 MPs/kg, and the largest proportion of MPs consists of fiber and chips of different shapes55. MPs removal rates for various processes in WWTPs are shown in Fig. 5. The studied WWTP is located close to Barcelona city with a design flow of 43,000 m3/day, a population of 358,000 equivalent inhabitants, and the production of dry sludge of 944 kg/h.

Figure 5
figure 5

Concentration of microplastics particles (MPs/L) per each treatment unit of wastewater treatment plant for summer and winter periods and removal rates (%) in the water line. (Adapted with permission from Ref.56).

Determining the abundance and tolerance of ARB and ARGs in traditional biological wastewater treatment units helps to reveal the fate and propagation mechanisms of ARB and ARGs57. Long-term interactions between a large number of microorganisms in AS and antibiotics in sewage will facilitate the generation and propagation of ARB or ARGs58. Tetracycline is used in large quantities as a broad-spectrum antimicrobial and is often detected in WWTPs59,60. Plenty of tetracycline-resistant bacteria have been found in AS, and tetracycline resistance increases with an increasing tetracycline concentration. AS and sequencing batch reactors (SBRs) dramatically depresses the abundance of ARGs (namely, vanA, ereA, ampC, aacC1, tetA and sulI)61, the removal rates were 2.4–4.2 log and 1.7–3.6 log, respectively. However, absolute abundance of ARG measured from anaerobic sludge (4.3 × 10−1) was lower than that in aerobic sludge (3.7 × 100). Studies have revealed that the main place where HGT occurs is in aeration tanks62, while anaerobic or hypoxic tanks can limit the production of ARGs. Microbial biomass and mobile genetic elements (MGEs) may yield opposite results, and higher microbial metabolism in aerobic digestion favors the occurrence and spread of ARB or ARGs. In SBRs, the microbial community structure changes significantly. One study found a strong correlation between tetracycline resistance and the abundance of functional bacteria (such as nitritolite, dechlorinomatons, and erythrobacillus) in sludge. MGEs and biomass are thought to be the main drivers of ARGs enrichment and spread63. It has been observed that functional bacteria in sludge are closely related to ARGs, and the transmission mechanism and other environmental drivers between them should be explored.

The mechanisms and influencing factors of MPs adsorption of antibiotics

MPs have a strong adsorption effect with respect to antibiotics and can be used as carriers to affect the degradation process of antibiotics in the natural environment64. The degree to which MPs can absorb antibiotics depends on their properties and interaction forces (hydrogen bonding, surface properties, electrostatic interactions, hydrophobic interactions, van der Waals forces, and π–π interactions). Figure 6 illustrates the interactions and influencing factors between MPs, antibiotics, and ARG. Environmental chemicals can also affect the adsorption process; for instance, the anionic surfactant sodium dodecylbenzenesulfonate can effectively combine with Polystyrene (PS) and Polyethylene (PE), enhance their surface electronegativity, reduce the Gibbs free energy of the adsorption system, and significantly improve adsorption capacity65. The size and shape of MPs also play an important role in the adsorption process, and fibrous spherical MPs have a stronger adsorption capacity toward antibiotics in water66. However, increased salinity in the environment can reduce the adsorption of antibiotics by MPs67. MPs have strong adsorption capacity for antibiotics, and this adsorption behavior is affected by many factors. In general, MPs can be used as carriers of antibiotics in the environment, promoting the spread and prevalence of antibiotics and ARGs68.

MPs as carriers of ARGs

ARGs are an emerging contaminant69, and some intracellular ARGs (i-TetA, i-TetC, i-TetO, and i-sul1) and extracellular ARGs (e-TetA and e-blaTEM) preferentially adsorb onto the surfaces of MPs70 (Table 1). The biofilm formed on MPs may change the morphology and physicochemical properties of the MPs themselves71. ARGs-containing microorganisms are selectively enriched in the biofilm of MPs, further improving adsorption capacity72. However, MPs biofilms provide a good environment for bacterial pathogens, and in some pathogens, ARGs are only found in MPs biofilms67. Driving mechanisms of ARGs enrichment by microplastic biofilm are presented in Fig. 7. MPs biofilms are significantly enriched in terms of the abundance of bacteria, pathogens, anti-ARGs, and MGEs, while increasing plasmid transfer between bacterial species73. MPs promote the spread of ARGs by acting as carriers.

Figure 6
figure 6

Interactions among microplastics, antibiotics as well as antibiotic resistant bacteria and genes in wastewater treatment plant. (Adapted with permission from Ref.74).

Figure 7
figure 7

(a) Direct adsorption of antibiotics (ATS) and ARGs and selection pressure. Direct adsorption of ATS and ARGs by MPs biofilm played an important role in ARGs enrichment. (b) Selection pressure on microbial communities on the surface of MPs biofilm and the type and concentration of ATS are important factors in determining the abundance and distribution of ARGs. (c) extracellular polymers (EPS) optimization effect. The abundance of EPS in the MPs biofilm is another important factor in enhancing the adsorption capacity. (d) Enrichment of ARB and microbial colonization preference. MPs biofilm can provide a suitable environment for the selective growth and spread of ARB and reduce the impact of ATS on microorganisms to some extent, prompting more bacteria to carry ARGs. (e) Evaluation of biofilm α-diversity by Shannon–Wiener calculations concluded that MPs biofilm had higher α-diversity and a significantly higher Shannon index than leaves and quartzite. (f) HGT processes such as phage transduction (transduction), intercellular gene conversion through pilus (conjugation), and DNA uptake and utilization (transformation). (Adapted with permission from Ref.75).

Effects of MPs aging on antibiotics and ARGs

MPs gradually age after being subjected to a series of physical, chemical, and biological effects in WWTPs, and the adsorption effect of MPs is strengthened via their aging76. After aging, MPs’ surface morphology and microstructure change77. The outer surfaces of MPs change from smooth to rough, cracked and concave. The surfaces of MPs have a negative charge, and number of the oxygen-containing functional groups significantly increases, which enhances hydrophilicity and adsorption effects78. At the same time, aging MPs releases additives (flame retardants, antioxidants and plasticizers) into the environment79. Polymer raw materials (monomers or oligomers)80 are reinforced against heavy metals81,82 and the adsorption power of organic pollutants83. MPs have a high adsorption capacity for low-polarity chemicals, such as polycyclic aromatic hydrocarbons, before aging84, in addition to polychlorinated biphenyls85, polybrominated diphenyl ethers86, and perfluoroalkyl acids87. After MPs have aged, oxygen-containing functional groups such as carbon groups (–C=O), carboxyl groups (-carboxy) and hydroxyl groups (–OH) are produced on their surfaces88,89,90, their hydrophobicity decreases, and MPs enhance the adsorption effect of highly hydrophilic and polar compounds such as sulfonamides, fluoroquinolones, tetracyclines and β-lactam antibiotics91. In addition, organic and inorganic contaminants such as antibiotics and metals adsorbed onto MPs biofilms have the potential to contribute to the production and spread of ARGs92. For example, zinc, a transition metal, is commonly used in industry and animal husbandry to jointly select the production of ARGs and induce their proliferation93. The interaction between MPs and ARGs is shown in Table 2.

Table 2 Enrichment of resistance genes in microplastics.

Impact of MPs on WWTPs and the spread of ARGs

The AS method has the advantages of offering a dense microstructure, good sedimentation performance, high sludge retention concentration, and an abundant number of microorganisms, and is widely used in WWTPs sewage treatment. Due to its special spherical structure, AS contains ammonium oxidizing archaea and bacteria, nitrite oxidizing bacteria, denitrifying bacteria, and polyphosphate accumulation organisms, which are highly resistant and can remove carbon, nitrogen, and phosphorus at the same time106. However, MPs from polyethylene107, polystyrene, and polyethylene terephthalate affect the function of AS51,108. MPs are small in size and easily accumulate in AS during sedimentation109,110. Higher concentrations of organic matter, MPs, and antibiotics in sewage interact with a great quantity of microorganisms in AS, promoting the production and dissemination of ARGs and ARB. Table 3 shows the effects of MPs on different processes and resistance genes in WWTPs.

Table 3 Effect of microplastics on the performance of different treatment processes and resistance genes in wastewater treatment plants.

Effect of MPs on COD removal rates

The removal rate of COD is an important indicator of the strength of digestive function. The size and concentration of MPs have an impact on COD removal rates. In one study, when the MPs content in AS was very low (1.0 mg/L), the average concentrations of COD in the effluent satisfied the relevant specifications (less than 50.0 mg/L)118. When the concentration of PVC MPs increased to a higher concentration (50.0 mg/L), the removal rate of COD decreased to 78.3% ± 6.4%115. It can be seen that a higher MPs concentration reduces the removal rate of COD, and it may be that the microorganisms in AS are inhibited. However, the removal efficiency of COD was above 92.7% when AS was exposed to 10.0 μg/L MPs, 1000.0 μg/L MPs, 10.0 μg/L NPs, and 1000.0 μg/L NPs, and there was no significant difference in the removal rate of COD without MPs99. At this time, the removal rate of COD can remain stable and efficient for a long time, and it may be that the microorganisms in AS may develop tolerance to MPs by secreting extracellular aggregates.

Effects of MPs on nitrogen and phosphorus removal

During aerobic digestion, MPs reduce the removal rate of total nitrogen (TN). For example, 0.5 mg/L, 5.0 mg/L, and 50.0 mg/L polyvinyl chloride reduced the average removal efficiency of TN without MPs from 89.4% to about 41.9%, and the average removal efficiency of TN at the concentration of these three MPs was the same. NH4+–N and NO2–N could not be detected in the effluent, but the content of NO3–N increased, indicating that PVC MPs may promote nitrite oxidizing bacteria activity115. However, different types of MPs had different effects, such as the effect of 1 mg/L PE and PS on the gathering of NO2–N. When the concentration of MPs continued to increase, PVC, PA and PS significantly inhibited the removal rate of ammonium nitrogen, and it is worth noting that when the concentration of MPs increased to 100.0 mg/L, the inhibitory effect of MPs on AS nitrification disappeared118. In general, MPs affected the removal rate of TN122, and the removal effect of nitrogen was affected by the concentration and type of MPs.

In WWTPs, BPR is an important step in the wastewater treatment process123. When the AS contained 10.0 μg/L and 1000.0 μg/L MPs, the removal efficiency of soluble orthophosphate (SOP) was high, exceeding 92.3% and 91.8%, respectively. When the sludge contained 10.0 μg/L and 1000.0 μg/L NPs, the SOP removal efficiency was greater than 91.9% and 92.1%, respectively99. A similar situation has emerged in constructed wetland phosphorus removal systems106. It can be seen that MPs concentration and size have no great effect on the removal rate of total phosphorus (TP) of AS, possibly because polyphosphate accumulation organisms change from Acinetobacter to unclassified gamma Proteus, which tolerates MPs better. However, in the case of PVC exposure, a different situation has emerged. When exposed to 0.5 mg/L PVC MPs, the removal efficiency of average TP remained at 90.0%, which was close to the removal effect without MPs, and the TP removal efficiency was seriously affected (38.8%) as the concentration of PVC increased to 5.0 mg/L. However, when the PVC content increased to 50.0 mg/L, the average TP removal efficiency returned to a higher level (87.7%)115. The TP removal rate of AS fluctuates with the type and concentration of MPs. The change in the removal rate of TP may be due to the toxic effect of MPs on microorganisms of AS, and as the reaction progresses, the functional microorganisms in AS were converted into more tolerant gamma Proteus, and the removal efficiency of SOP could be maintained at a high level124.

MPs facilitate the spread of ARGs

The removal effect of AS antagonistic genes is provoked by MPs. A recent study showed that aerobic digestion can achieve better ARGs removal performance due to the rapid removal of volatile solids (VS) and the narrow range of potential ARGs hosts125. Although high removal efficiency of ARGs has been demonstrated in previous studies, exposure to MPs in sludge reduces the removal rate of ARGs from aerobic sludge nitrification processes126. During aerobic digestion without MPs, the abundance of ARGs was reduced by about 85.3%. However, with the presence of polyvinyl chloride, PE and PET MPs, the total absolute abundance of ARGs increased by 129.6%, 137.0% and 227.6%, respectively. At the same time, the MPs changed the microbial community of sludge, and the main reasons for this change may be the toxicity of MPs and biofilms on the surfaces of the MPs127. In addition, MPs also contribute to the abundance of intI1 in sludge, suggesting that MPs may increase the frequency or chance of HGT between bacteria. MPs exert selective pressure on microorganisms. Biofilms formed on the surface of MPs generally have higher bacterial density than natural water environments, biofilms can also enhance plasmid stability, expanding the host range of HGT and thus increasing the frequency of gene exchange between bacteria117,128. There is growing evidence that MPs can promote bacteria to produce more reactive oxygen species or reactive oxygen radicals and that reactive oxygen species (ROS) can activate the expression of intI1 in cells, increasing the frequency of HGT129.

MPs promote the enrichment and spread of ARGs during anaerobic digestion. Metagenomic sequencing was used to detect an increase in the abundance of ARGs in anaerobic digesters with PE- and PVC-MPs added compared to control group. Moreover, these ARGs were mainly sulfonamides, lactams, and tetracycline ARGs, which are often reported in WWPT130 (Table 2). HGT is the main pathway of transmission between microorganisms in the environment. ARGs horizontal flow is affected by a variety of factors, including ROS production131,132, cell membrane permeability, EPS secretion, and adenosine triphosphate synthesis. The overproduction of bacterial ROS leads to DNA damage and increased permeability of cell membranes, thereby facilitating the horizontal flow of bacteria133. Cell membranes are key sites at which bacteria can take up genes. Plasmid-free or plasmid-carrying ARGs complete bacterial transformation and conjugation via transmembrane transport or cell fusion. In addition, EPS secreted by bacteria constitute a complex extracellular matrix consisting mainly of polysaccharides, proteins, and extracellular DNA134. EPS play an important role in promoting the HGT of bacteria. Because EPS can bind to the e-ARGs released by bacteria, increasing cell-to-cell adhesion, this provides favorable conditions for HGT. MPs increase the total abundance of EPS secretion-related genes and indirectly promote the spread of ARGs.

Effects of MPs hydrolysis, acidification, and methane production

Waste-to-activated sludge (WAS) is an extremely complex by-product of WWTPs that contains heterogeneous substances such as bacteria, pathogens, inorganic particles, colloids, heavy metals and persistent organic pollutants. If it is not properly treated, it will easily cause the secondary pollution of natural water, groundwater and soil, threatening environmental safety and public health. Since WAS contains a large amount of organic matter, such as protein and carbohydrates, it is also considered renewable bioenergy135.The anaerobic digestion of WAS is an effective pollution control and energy recovery technique that stably reduces WAS, kills pathogens, and produces biogas methane via biodegrading organic matter136,137. Anaerobic digestion involves three important biochemical processes: hydrolysis, acidification, and methanation. The degradation of organic matter is a key indicator of anaerobic digestion efficiency. During hydrolysis, soluble polysaccharides (SPSs) and soluble proteins (SPNs), the main components of soluble organic substrates, are further degraded into micromolecular monomers, however this process is influenced by MPs exposed to sludge.

MPs inhibit anaerobic digestion and hydrolysis. The rate of hydrolysis often determines the rate of overall anaerobic digestion138. Total chemical organic oxygen demand (TCOD), soluble chemical organic oxygen demand (SCOD), SPNs and SPSs in conditions of exposure to MPs AS. MPs reduce the removal rate of anaerobic nitrified TCOD, and the inhibition effect is enhanced with the reduction in MPs particle size, and small MPs may reduce the rate at which microorganisms use organic matter, inhibiting the conversion of microorganisms from solid to soluble parts, thereby affecting the final methane yield. The presence of MPs increases the time it takes for SCOD concentrations to drop. Moreover, at the end of digestion, the levels of SCOD, SPNs, and SPSs were mostly higher than that of a control group without MPs139, meaning that the hydrolysis of organic compounds was inhibited and possibly that the biological activity of hydrolyzed microorganisms was disturbed by MPs. For example, during the digestion of MPs PE, the concentrations of SPSs and SPNs were significantly lower than those in the control group. After 13.0 days of digestion, the SPSs and SPNs concentrations were approximately 79.1% and 56.7% respectively, those of the control group. The reason for the low SPSs and SPNs levels may be related to the presence of MPs inhibiting the conversion of organic matter from solid to liquid phase. The inhibited dissolution may be due to an increase in sludge particle size or a decrease in the production of EPS134.

After the hydrolysis of SPSs and SPNs, volatile fatty acids (VFAs) are produced during acidification140. During anaerobic digestion, the concentration of VFAs increases rapidly and then decreases. PE MPs prolongs the growth phase of VFAs and increases maximum yield. The total VFAs yield and individual VFA concentration in the PE MPs 180.0 μm and PE MPs 1.0 mm groups were significantly higher than those in the control group. After 40.0 days of digestion, the total VFAs and acetic acid concentrations of PE MPs-180.0 μm and PE MPs-1.0 mm were 1.7-fold and 1.5-fold, 7.1-fold, and 12.5-fold, respectively111. The increase in VFAs may provide more usable carbon sources for methanogens141. The MPs polyamide 6 increases the production of short-chain fatty acids (SCFAs), which are acidified products, including acetic acid, propionic acid, butyric acid and valerate142. Anaerobic digestion requires the involvement of multiple enzymes, which may be more attributable to the enhancement of key enzyme activity during acidification. In anaerobic digestion, proteins and polysaccharides are first hydrolyzed into amino acids and monosaccharides by proteases and α-glucosidases, respectively. The resulting amino acids are converted to SCFAs by BK and acetyl-CoA is translated into acetic acid by AK. Finally, methylation is carried out under the action of coenzyme F420141. PA6 MPs increase the activity of key enzymes, especially the activity of F420 increased to 200.0% that of the control. It can be seen that MPs alter the activity of key enzymes in the anaerobic digestion process, thereby controlling hydrolysis, acidification and methane production processes.

Toxicity of MPs and ARGs to the environment and human body

Global assessments show that most productive soils lack organic matter. Nutrients in the soil are transported along with crops to urban areas, and there is a serious nutrient imbalance in the agricultural system that may be counteracted by the application of sludge to soil143. Because sludge contains an abundance of nitrogen, phosphorus and other elements, which are important resources for the growth of plants, sludge turns waste into treasure144. For example, sludge is the third-largest source of phosphorus in Danish agriculture145. In addition, sludge is considered a soil amendment that can help improve soil structure and promote soil health146. However, more than 90.0% of the MPs in WWTPs eventually remain in the sludge, and the MP concentration may induce changes in the soil ecosystem, soil structure and soil physicochemical properties, such as pH and chemical composition147. The properties of MPs are conducive to the adsorption of hydrophobic organic pollutants, heavy metals, antibiotics, pathogenic bacteria and other pollutants148. PS particles can increase oxidative stress level of root tips, thereby deforming the apical epidermal cells and then pulling apart the protective layer between the epidermal cells149. PS particles passed unimpededly the external biological barrier of root tips, completing the bioaccumulation of MPs. MPs and the various pollutants that may be absorbed by plants or animals150, eventually being absorbed by the human body through the food chain, posing a great threat to human health. MPs have a cumulative effect with metals such as copper and cadmium that is commonly associated with these metal’s concentrations in the body151. Moreover, MPs can be more deeply integrated into the soil profile through tillage, bioturbation, and uptake in soil biomes, increasing the pore structure of the soil, expanding the radius of pollution with the help of groundwater, and completing vertical and horizontal transportation151. Significantly, the problems of antibiotics, ARGs, and ARB are prominent in sanitary landfill and land application processes. During sanitary landfill, antibiotics, ARGs, and ARB may leach out with the leachate and landfill leakage, and transfer to the recipient environment152.

MPs released into the aquatic environment may cause aquatic animals to choke or ingest MPs through their stomachs and eventually enter the food chain, this poses potential health risks to aquatic species and humans. Organisms can easily absorb MPs smaller than 20.0 μm153. NPs can easily enter the body in various ways154, leading to health problems relating to spects such as fertility, sex ratio, the reproductive system and weight155,156. In aquatic environments, biofilms on the surface of MPs promote the development of microbial communities157, constituting a unique biological location158, MPs are considered to be a reservoir for certain microorganisms, such as pathogenic bacteria, including ARB159. Developing countries have inadequate health care systems, characterized by an absence of necessary facilities and medications, and elevated ailment burden, which sequentially demands frequent use of antibiotics. The occurrence of antibiotics, ARGs, and ARBs in drinking water might disrupt the gastrointestinal microbiota balance and further affect human health160. However, the health risks posed by the biofilm formed on MPs are higher.

Biofilms and on-membrane microbes on the surfaces of MPs were found in both WWTPs and drinking water plants. Diatoms and spherical and filamentous bacteria colonized MPs in 63 drinking water samples from the Mexico City area. The biological composition of MPs biofilms includes not only the native microbial communities in the influent water, but also the bacteria in the AS of secondary sewage treatment161. MPs biofilms contains specific bacterial taxa that are more enriched with multidrug ARGs (smeE and mdsC) and ARGs (qnrVC6 and ermF) compared to rock and leaf biofilms67. Fifty-eight human pathogenic microorganisms were found to have colonized the biofilms of MPs at sources of drinking water, including Streptococcus coliitidis, Pseudomonas fluorescent, pseudomonas steppe, Klebsiella pneumoniae, Seudomonas insectacea, pseudomonas proteinogenes, pseudomonas enterica, Salmonella enterica and Aeromonas hydrophila, and movable genetic elements (intI1) on MPs have been found to play an important role in the horizontal transfer of sulfonamide ARGs101. MPs have a great role as vectors for potentially multi-drug resistant bacteria (such as Crystallium halobacteria, streptococcus, Pseudomonas, and lactic acid bacteria abundant in the plasma layer) and ARGs (such as sul2, a common ARGs conferring resistance to sulfonamides), which may have a negative impact on ecology and human health after exposure. WWTPs are the important source of bioaerosols and the high dynamics of atmospheric may lead to up regulated transmission rate and carrier of ARGs162. Compared to water-borne and soil-borne, ARGs in aerosols have higher health risks due to their ability to penetrate into the alveoli of the human lungs163. Common E. coli bacteria enter the human body through a variety of routes and pose a health threat, presenting in Fig. 8. ARG may cause toxicity, pathogenicity, and disease outbreaks and transmission164, for example, pseudomonas can cause skin diseases; Enterobacteriaceae and Aeromonas spp cause diarrhea; Acinetobacter can induce deadly infections such as pneumonia and meningitis; Campylobacter can cause sepsis165. In addition, ARGs (such as sul1 and sul2) associated with MPs tend to develop resistance to the action of sulfonamide antibiotics, which are widely used in human medicine and animal production to treat bacterial, protozoan and fungal diseases. All in all, MPs and heavy metals, antibiotics ARB, ARGs, and other toxic and harmful substances carried on MPs pose a major threat to health. Therefore, further research on the MPs-associated microbial communities in WWTPs and their removal mechanisms are needed.

Figure 8
figure 8

Transmission routes illustration of antibiotic resistant E. coli strains in natural environment. Possible spread routes of antibiotic resistant E. coli showed by arrows among reservoirs such as ducks, geese, chickens, dogs, pigs, cattle, WWTPs, agricultural fifield, and humans. The horizontal and vertical transmission of ARGs among bacteria in the environment can cause public health issue finally. (Adapted with permission from Ref.166).

Discussion

WWTPs have long been considered a reservoir of MPs, antibiotics, and ARGs. This study reveals the sources, roles, fates, and harm to human health of MPs and ARGs in WWTPs. MPs adsorb antibiotics through physicochemical action, generate biofilm-enriched microorganisms on the surfaces of MPs, and increase the abundance of ARGs and promote their spread. The effects of MPs type, size, concentration and other factors on COD, nitrogen and phosphorus removal, hydrolysis, acidification and methanation in sludge digestion were revealed. It is worth noting that the exposure of MPs promotes the spread of ARGs in the entire sewage treatment process, reduces the removal rate of ARGs and increases their absolute abundance. WWTPs discharge sewage sludge containing MPs, ARB, ARGs and other pollutants into water and soil environments, causing environmental pollution and even threatening human health. Although the current research on MPs, antibiotics, ARB, and ARGs has made some progress, it is necessary to continue to conduct in-depth research with respect to the following aspects.

  1. 1.

    At present, the detection and characterization technology of MPs is not sufficiently developed, and the detection technology of NPs is still in its infancy, and it is necessary to improve detection technology in this regard, clarify the quantitative and qualitative research of MPs and NPs, and provide a research basis for the toxicological study of MPs and NPs. At present, the potential impact of MPs on the digestion of AS is only a “black box”. The quantitative and qualitative study of MPs can help to further improve the effect of sludge digestion.

  2. 2.

    The environmental hazard posed by WWTPs are mainly due to the discharge of sewage sludge rich in pollutants such as MPs, antibiotics, ARB and ARGs into water bodies or soil. The concentration of pollutants in the remaining sludge is much higher than that of sewage, and the landfill treatment of sludge not only pollutes the soil, but also penetrates into the groundwater and causes a wider range of pollution. Sludge is also often used in agriculture as organic fertilizer, and contaminants in sludge can enter the human body through the food chain, threatening human health. Studying the desorption mechanisms of MPs with respect to pollutants is the key to reducing environmental pollution, safely using it in agriculture, and turning waste into treasure.

  3. 3.

    The presence of MPs reduces the removal rate of ARB and ARGs in WWTPs. MPs can selectively enrich ARGs and MGEs in the environment, and some ARGs can only be detected on the biofilms of MPs. Additionally, the factors, mechanisms and dynamics driving this process are not clear, yet they are essential to reducing the abundance of ARGs and limiting their spread.

  4. 4.

    A raised overall detection frequency of many antibiotics was detected in the children, who have higher consumption of poultry meat, livestock, dairy, milk and aquatic products. There is a need to develop novel classes of antimicrobials or to restrict the use of currently available drugs for combating with the worse situation.