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 National Action Plan (NAP) for antimicrobial resistance (AMR). In Ghana, a particular problem of interest is the fact that wastewater effluents are generally untreated and often discharged into water bodies. The Ministry of Health and its implementing bodies are interested in 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. This project’s collaboration with the Ministry helps to situate it within the national priorities of the Ghana AMR Policy.


AMR poses a critical health threat with major economic and societal consequences. Globally, 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, spilling 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

This project aims to implement and assess modular advanced solutions for effective and decentralised wastewater treatment at selected point sources of AMR emergence. The applied technologies will primarily target 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 project will also assess 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 decentralised treatment of AMR in LMICs.


Building on recent advances in the fundamental understanding of the molecular, ecological and evolutionary drivers of mobile AMR in bacteria. This research aims to translate this robust theoretical foundation into One Health interventions. In particular, the team will develop novel interventions aimed at selectively eliminating AMR from complex microbiomes focusing 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.

Download project summary

Demonstration Project

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