Antibiotic resistance in European wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence

Katariina M. M. Pärnänen, Carlos Narciso-da-Rocha, David Kneis, Thomas U. Berendonk, Damiano Cacace, Thi Thuy Do, Christian Elpers, Despo Fatta-Kassinos, Isabel Henriques, Thomas Jaeger, Antti Karkman, Jose Luis Martinez, Stella G. Michael, Irene Michael-Kordatou, Kristin O’Sullivan, Sara Rodriguez-Mozaz, Thomas Schwartz, Hongjie Sheng, Henning Sørum, Robert D. StedtfeldJames M. Tiedje, Saulo Varela Della Giustina, Fiona Walsh, Ivone Vaz-Moreira, Marko Virta*, Célia M. Manaia

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

317 Citations (Scopus)


Integrated antibiotic resistance (AR) surveillance is one of the objectives of the World Health Organization global action plan on antimicrobial resistance. Urban wastewater treatment plants (UWTPs) are among the most important receptors and sources of environmental AR. On the basis of the consistent observation of an increasing north-to-south clinical AR prevalence in Europe, this study compared the influent and final effluent of 12 UWTPs located in seven countries (Portugal, Spain, Ireland, Cyprus, Germany, Finland, and Norway). Using highly parallel quantitative polymerase chain reaction, we analyzed 229 resistance genes and 25 mobile genetic elements. This first trans-Europe surveillance showed that UWTP AR profiles mirror the AR gradient observed in clinics. Antibiotic use, environmental temperature, and UWTP size were important factors related with resistance persistence and spread in the environment. These results highlight the need to implement regular surveillance and control measures, which may need to be appropriate for the geographic regions.
Original languageEnglish
Article numbereaau9124
JournalScience Advances
Issue number3
Publication statusPublished - 27 Mar 2019


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