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Antibiotic Resistance in Wastewater Treatment Plants and Transmission Risks for Employees and Residents: The Concept of the AWARE Study

By Laura Wengenroth, Fanny Berglund, Hetty Blaak, Mariana Carmen Chifiriuc, Carl-Fredrik Flach, Gratiela Gradisteanu Pircalabioru, D. G. Joakim Larsson, Luminita Marutescu, Mark van Passel, Marcela Popa, Katja Radon, Ana Maria de Roda Husman, Daloha Rodriguez-Molina, Tobias Weinmann, Andreas Wieser, Heike Schmitt

Posted 05 Feb 2021
medRxiv DOI: 10.1101/2021.02.03.21250668

Background: Antibiotic resistance has become a serious global health threat. Wastewater treatment plants (WWTPs) may become unintentional collection points for bacteria resistant to antimicrobials. Little is known about the transmission of antibiotic resistance from wastewater treatment plants to humans, most importantly to WWTP workers and residents living in the vicinity. We aim to deliver precise information about the methods used in the AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Waste Water Treatment Plants) study. Methods/Design: Within the AWARE study, we gather data on the prevalence of two antibiotic resistance phenotypes, ESBL-producing E.coli (ESBL-EC) and carbapenemase producing Enterobacteriaceae (CPE) as well as on their antibiotic resistance genes (ARGs) isolated from air, water, and sewage samples taken from inside and outside of different WWTPs in Germany, Netherlands and Romania. Additionally, we analyse stool samples of WWTP workers, nearby residents and members of a comparison group living at least 1,000 m away from the closest WWTP. Discussion: The study results will enable the assessment of the potential health impact of exposure to ESBL-EC ,CPE and ARGs in and around WWTPs. Quantifying the contribution of different wastewater treatment processes to the ESBL-EC, CPE and ARGs removal efficiency will provide us with evidence-based support for possible mitigation strategies.

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