26. April 2022

Removal of AMR genes and bacteria from wastewater using modular advanced treatment solutions (HOTMATS)


Region: Africa Sector: One Health Country: Ghana Project type: Supporting project Country partners: University of Ghana, College of Health Sciences Funding partners: JPIAMR Research Partners: Karslruhe Institute of Technology (KIT), Germany; Norwegian Institute of Water Research (NIVA), Norway; University of Nairobi, Kenya Timescale: February 2022- January 2024 ICARS funding: 250,000 EURO


The environment and water bodies are largely unattended and remain a high priority in the National Action Plan (NAP) for antimicrobial resistance (AMR). A particular problem of interest is the fact that wastewater effluents in Ghana are generally untreated and often discharged into water bodies. The Ministry of Health and its implementing bodies are interested in research tailored solutions that can be implemented on the ground in low- and middle-income countries (LMICs) to reduce antibiotic resistant bacteria (ARB) and genes (ARG)  in wastewater effluents. The collaboration with the Ministry helps to situate this project within the national priorities of the Ghana AMR Policy.

In addition, the participating Ghanaian researchers are members of the Ghana Technical Working Group on AMR surveillance (a multi-disciplinary group that seeks to tackle ARB using a One Health approach) bringing expertise from human, animal and environmental health. The team provides an LMIC One Health setting with experts capable of piloting the novel water modular treatment system. The research laboratories at the Department serve as the national reference lab for the Ghana AMR surveillance and will contribute clinical diagnostics experience to the project. Through collaborations with key government institutions and agencies, in particular the Minister of Health, the project aims to leverage our findings towards the urgent implementation of interventions to effectively treat wastewater effluents.


Antimicrobial resistance (AMR) presents one of today’s major health challenges with major economic consequences to the society. Global AMR dissemination is mainly due to the emission of antibiotic resistant bacteria (ARB), antibiotic resistance genes (ARG), facultative pathogenic bacteria (FPB) and AMR driving substances contained in human and animal waste into the environment. Much effort has been spent on unravelling the sources, sinks and transmission pathways of AMR in a number of AMR screening studies globally. The main hotspots of anthropogenic AMR include:

  • point-sources, e.g., hospitals, nursing homes, domestic households, the pharmaceutical industry, animal husbandry, and slaughterhouses
  • urban wastewater treatment plants (WWTPs)
  • other diffusive sources.

The effluents from AMR hotspots are mostly discharged into the public sewage system, which plays an important role as a recipient of potentially harmful and AMR-driving substances as well as ARB & ARGs.

“The project provides a unique opportunity to test state-of-the art technological solutions in varied real-life settings (low-middle-high income countries) simultaneously. This will help provide valuable learnings for better, quicker and context-specific deployment of technological innovation for AMR mitigation.” – Jyoti Joshi, AMR Advisor, ICARS

Project overview

The project aims to implement and assess modular advanced solutions for effective and decentralized wastewater treatment at selected point sources of AMR emergence. The applied technologies are primarily targeting AMR pollution and pathogens in wastewater streams directly at AMR hotspots. This means moving away from ‘end-of-pipe’ approaches applied at wastewater treatment plants (WWTPs) and address intervention in all three pillars of One Health. The project will help to use an advanced system to destroy antimicrobial resistant bacteria (ARB) and facultative pathogenic bacteria (FPB) in wastewater.

The research team also aims to demonstrate the superiority of the novel pilot-scale treatment systems as opposed to state of-the art solutions by collecting and treating effluents from AMR hotspots, including a hospital, nursing homes, and a slaughterhouse. This will reduce the risk associated with ARB/FPB spreading from hotspots to the downstream natural environment, and to unburden central WWTPs.

The modalities for technology transfer from high income countries (HICs) to low- and middle-income countries (LMICs) by conducting a willingness to pay study for uptake of decentralized treatment of AMR in LMICs will also be assessed.


The research builds on recent advances in the fundamental understanding of the molecular, ecological and evolutionary drivers of mobile AMR in bacteria, and the overall goal of this project is to translate this robust theoretical foundation into One Health interventions. The team will develop novel interventions aimed at selectively eliminating AMR from complex microbiomes. These will focus on:

  • delivery of Sequence Specific Antimicrobials (SSAs) by probiotics to destroy resistant cells and AMR plasmids
  • blocking the cell-to cell transfer of AMR plasmids by phage therapy using pilus dependent bacteriophage (PDB).

This novel AMR targeting approach offers the possibility of eliminating AMR without producing significant alterations to the microbiome and the adverse effects associated with dysbiosis, which include enhanced susceptibility to pathogen infection.

Demonstration Project

Mitigating the spread of antimicrobials and resistant microbes through treatment of manure