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4.1 Urban waste water treatment and AMR
The major known sources and transmission routes for AMR are through health and food applications. Pathways to the environment through urban waste water treatment largely arise from people excreting resistant bacteria themselves, or taking medicine and excreting some of the active ingredient, which may allow bacteria in the environment to develop resistance.
Gene transfer can take place in urban waste water treatment plants, though the rate and extent may be dependent on a range of factors, including the type of treatment applied. The longer the effluent is stored, the more opportunity there may be for AMR to be generated. This creates challenges: for instance, while disinfection is used to reduce the bacterial load, the waiting time between secondary treatment and disinfection can allow resistant bacteria to grow.
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Exposure to heavy metals or desinfectants can e. g. induce bacterial adaptions resulting in reduced susceptibility to antibiotics.
Wales, A.D. and Davies, R.H. 2015. Co-selection of resistance to antibiotics, biocides and heavy metals, and its relevance to foodborne pathogens. Antibiotics 4: 567-604.
I would not focus on the effluent but on the sludge. The hydraulic retention time in a WWTP is in general around 24h when the retention time of sludge is from 4 to 12 days in the water tretament steps and even longer for the sludge treatment steps.
"This creates challenges: for instance, while disinfection is used to reduce the bacterial load, the waiting time between secondary treatment and disinfection can allow resistant bacteria to grow."
It does not seem very significant to consider this case. The hydraulic retention time between those 2 treatment steps is rather short (min).
I agree
The longer the hydarlic residence time during wastewater treatment the more opportunity there may be for AMR to be generated. Also, disinfection used to reduce the bacterial load, may lead to bacteria regrowth.