The Fate and Occurrence of Antibiotic-Resistant Bacteria and Antibiotic Resistance Genes during Advanced Wastewater Treatment and Disinfection: A Review

Antimicrobial resistance (AMR) is a serious problem for modern society, not only associated with clinical environments, but also the natural environment. Conventional wastewater treatment plants (WWTPs) are important nodes for the dissemination of antibiotic resistance to the aquatic environment since they are reservoirs of antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARGs), and antibiotic residues. WWTPs are not designed to remove these antibiotic resistance determinants from wastewater, and as a result, they are present in treated effluent, leading to environmental and public health concerns regarding wastewater disposal and reuse. Additional treatments combined with conventional WWTPs can be barriers to the spread of AMR to the environment. In order to understand the effect of wastewater treatment methods on the removal of ARB and ARGs, an extensive bibliographic study was conducted. This review summarizes the efficiency of conventional disinfection methods, tertiary wastewater treatment, and advanced oxidation processes (AOPs) to remove ARB and ARGs from wastewater. In the context of the revised Urban Wastewater Treatment Directive 91/271/EEC, further studies are needed on the removal potential of AOPs on a full-scale, as they offer great potential for the removal of ARB and ARGs with a low formation of toxic by-products compared to conventional disinfection methods.