A comprehensive review of antibiotics stress on anammox systems: Mechanisms, applications, and challenges.

Anaerobic ammonia oxidation (anammox), an energy-efficient technology for treating ammonium-rich wastewater, faces the challenge of antibiotic stress in sewage. This paper systematically evaluated the impact of antibiotics on anammox by considering both inhibitory effects and recovery duration. This review focused on cellular responses, including extracellular polymeric substances (EPS), quorum sensing (QS), and enzymes. Then, the physiological properties of cells and the interactions between nitrogen and carbon metabolism under antibiotic stress were discussed, particularly within the anammoxosome. The microbial community evolution and the development and transfer of antibiotic resistance genes (ARGs) were further analyzed to reveal the resistance mechanisms of anammox. To address the limitations imposed by antibiotics, the development of bio-augmentation and combined processes based on molecular biology techniques, such as bio-electrochemical systems (BES), has been suggested. This review offered new insights into the mechanisms of antibiotic inhibition during the anammox process and aimed to advance their engineering applications.