Antibiotic resistance fate in the full-scale drinking water and municipal wastewater treatment processes: A review

Antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) have been widely identified as emerging pollutants in various aquatic compartments. Concerns have been raised that the antibiotic resistance determinants may occur in treated drinking water and wastewater, weakening the therapeutic efficacy of antibiotics and so posing threat to public health. Most often, laboratory trials are conducted to assess the removal efficiency of ARB and ARGs in individual treatment processes (e.g., disinfection). However, the random variations of microbial distribution and chemical compositions in real-world environments cannot be entirely simulated, presumably leading to false-positive results as a consequence. It is therefore useful to provide a summary of recent advancements regarding the antibiotic resistance attenuation during full-scale water/wastewater treatments, which has not been adequately evaluated so far. In this review, the prevalence, proliferation and transmission of ARB and ARGs in urban water cycle, coupled with corresponding detection methods are presented as a short overview. The fate of ARB and ARGs in the sequential drinking water and wastewater processing units is critically summarized, the aim of which is to provide guidance for improving the current water treatment facilities to further reduce the antibiotic resistance in finished water.