1) Executive summary

Antimicrobial resistance is a worldwide, increasing threat to human health. International cooperation to tackle it started with the transatlantic taskforce on AMR in 2009[1], growing to a UN High Level Meeting on AMR in 2016[2] and G20 Berlin Declaration in 2017[3]. Its threat level is now considered to be on a par with climate change[4].

Health and food sectors are heavily involved in action to mitigate the risk but there has been limited action in the third part of the potential exposure/transmission pathway, environment.

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Urban waste water treatment (UWWT) is key to protecting environment and human health. The investment in UWWT is substantial, with a planned lifetime of many decades. Urban waste water treatment plants (UWWTPs) receive waste waters from many upstream sources but act as a point source, from where pollutants can enter rivers, lakes and coastal waters. Treatment taking place at UWWTPs represents the last chance to prevent pollutant releases into sewers reaching the environment.

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Key findings were summarised for the topics of monitoring, the release of treated urban waste water and transmission of AMR, and options for reducing the potential of transmission. Knowledge levels varied – from those where general agreement could be reached, to unclear and unknown situations. Priority knowledge gaps were identified as being:

  • Impact of urban waste water treatment on AMR;
  • Monitoring for information on spatial and temporal trends in the environment;
  • AMR exposure from the environment to humans;
  • Quantification of risk, or contribution to acute cases of AMR, from urban waste water treatment discharges;
  • Understanding evolution and selection in collection and sewerage systems, urban waste water treatment plants and hospitals.

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