Antimicrobials in sewage treatment plants : occurrence, fate and resistance

Abstract: The World Health Organization (WHO) has identified antibiotic resistance as a major threat to human health. The environment has been suggested to play an important role in the emergence of antibiotic resistant bacteria. The external environment can act as a source of resistance genes that could potentially be transferred into human pathogens. It is also an important route for the dissemination of antibiotic resistance genes and bacteria. Sewage treatment plants (STPs) are among the most important routes by which antibiotics and antibiotic resistance genes enter the environment. It has been suggested that STPs are hotspots for the development of antibiotic resistance because they contain relatively high concentrations of antibiotics as well as both human and environmental bacteria. Further complicating matters, there is evidence that other substances with antimicrobial properties, such as biocides and metals, can cause antibiotic resistance due to co- and cross-resistance.This thesis contributes new knowledge on the concentrations, mass flows, and removal efficiencies of antimicrobials in STPs and their connections to the emergence of antibiotic resistance. Paper I presents data on the levels of 40 different antimicrobials in the incoming wastewater, treated effluent, and digested sludge of eleven different STPs. Although not previously detected in STPs, chlorhexidine is shown to be ubiquitous in such plants. In Paper II, mass flows and removal efficiencies are calculated for eleven antimicrobials over various treatment steps in three STPs, showing that polar antimicrobials were inefficiently removed from the wastewater. In Paper III, the minimum selective concentration (MSC) for the antibiotic tetracycline was determined in a complex bacterial aquatic biofilm using both phenotypic and genotypic endpoints. It was found that 10 µg/L selected for phenotypic resistance, and 1 µg/L selected for certain resistance genes. Paper VI used metagenomics to determine whether there is selection for antibiotic-resistant bacteria in STPs and whether the extent of this selection can be correlated to the concentrations of antimicrobial compounds. No clear evidence for selection was identified. Paper V evaluates advanced wastewater treatment techniques for removing antimicrobial compounds using ozonation and granular activated carbon (GAC). The identity of the GAC material was found to strongly affect removal efficiency, and GAC was more efficient than ozonation for most compounds at the tested concentrations.