Abstract

Within the One Health framework, constructed wetlands (CWs) are increasingly recognized as sustainable systems for mitigating antibiotic resistance (AR). However, their effectiveness in reducing—or potentially contributing to—the dissemination of AR remains debated. This review analyzes recent literature (2024–2025) to clarify the capacity of CWs in AR control. Bibliometric analysis indicates that current research mainly focuses on (1) novel substrates such as biochar, (2) integration with innovative technologies such as microbial fuel cells (MFCs), and (3) characterization of resistant microbial communities. Reported performances of CWs with biochar or coupled with MFCs show antibiotic removal efficiencies of 41–99 % and AR genes (ARGs) reductions of 0.5–1.0 log units. These results evidence that CWs are capable of decreasing ARGs and antibiotics rates from wastewater. However, more research is needed for improving performance and for scaling laboratories prototypes to real-scale CWs. Focusing on ARGs’ occurrence, they are frequently detected in CW substrates and effluents, with abundances up to 104 copies/mL and 10?2 copies/16S rDNA gene copy, respectively. Microbial community studies further suggest ARGs mobilization within CWs—from influent to substrates and plants—and their potential release into surrounding environments. Overall, CWs appear to function as “AR buffer systems”: reducing ARGs levels in liquid streams while facilitating their accumulation in substrates. This reservoir may pose environmental risks, particularly through the reuse of CW biomass in agriculture. Therefore, future research should prioritize risk assessment of CW substrates as potential vectors of AR dissemination. © 2025 Elsevier B.V.