Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Waste Water Treatment Plants (AWARE-WWTP)



The rise of antibiotic resistant infections is an imminent global public health threat, and Antibiotic resistance is a major health care concern worldwide. Wastewater (sewage) is considered an important source of dissemination of antibiotic resistant bacteria and resistance genes (ARB/ ARGs) to the environment.

Completed project

AWARE investigated whether people working at wastewater treatment plants (WWTP) and people living in the vicinity of WWTP have an increased risk of carriage of ARB/ARGs through exposure to contaminated water or air. This was studied in Germany, the Netherlands and Romania.

The main conclusion was that WWTP workers and nearby-residents may be at greater risk of carriage of ABR than the general population in some (as was shown for Romania) but not in other countries (as was shown for Germany and the Netherlands). Also, the results suggest that elevated carriage in Romanian nearby residents were not likely to be directly caused by the WWTP. Further analyses will quantify exposure risks and shed light on the role of WWTP in selection of antibiotic resistance.

Project partners

  • Heike Schmitt, National Institute for Public Health and the Environment (RIVM), Netherlands (Coordinator)
  • Carmen Chifiriuc, University of Bucharest, Romania
  • Joakim Larsson, University of Gothenburg, Sweden
  • Katja Radon, Ludwig-Maximilians-Universität, Germany
  • Susan Pettersson, Water and Health, Australia
  • Kate Medlicott, World Health Organization (WHO), Switzerland
  • Peter Ulleryd, Västra Götaland och Regionala Strama Södra Älvsborgs Sjukhus, Sweden

Project resources