Antibiotic resistance is a growing global concern, with municipal solid waste (MSW) landfills recognized as significant reservoirs of antibiotic-resistant bacteria and antibiotic resistance genes (ARGs). This review focuses on the emergence and spread of antibiotic resistance within landfill ecosystems and its consequent environmental impacts. It synthesizes research findings from 2018 to 2024, highlighting the persistence of resistance genes in landfill leachate, soil, air, and water. Particular emphasis is placed on the role of landfill environmental conditions in facilitating horizontal gene transfer and enhancing microbial adaptation. The review discusses how ARGs enter MSW landfills primarily through pharmaceutical waste, health care activities, agricultural runoff, and industrial discharges. Additionally, it examines current mitigation strategies, including engineered landfill designs, bioremediation using microbial consortia, development of environmentally sustainable pharmaceuticals, and enforcement of global regulatory frameworks. The analysis identifies critical research gaps, particularly in low- and middle-income countries, underscoring the urgent need for enhanced surveillance, standardized monitoring, and stringent regulations. The study recommends a multidisciplinary approach that integrates expertise from waste management, environmental science, microbiology, and public health to effectively tackle antibiotic resistance in landfill environments.
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