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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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Quantification of risk, or contribution to cases of AMR due to direct or indirect exposure to urban waste water treatment discharges, eg. through leisure activities in rivers or lakes, or irrigation of crops with surface water with WWTPs discharges;
Quantification of benefits from potential measures vs cost of implementation or cost of non-action.