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Sci Adv. 2019 Mar 27;5(3):eaau9124. doi: 10.1126/sciadv.aau9124. eCollection 2019 Mar.

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

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Department of Microbiology, University of Helsinki, Viikinkaari 9, 00014 University of Helsinki, Finland.
Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Rua Arquiteto Lobão Vital, 172, 4200-374 Porto, Portugal.
Technische Universität Dresden, Institute of Hydrobiology, Dresden, Germany.
Department of Biology, Maynooth University, Maynooth, Co. Kildare, Ireland.
Aquantec GmbH, Pfinztalstraße 90, D-76227 Karlsruhe, Germany.
Department of Civil and Environmental Engineering and Nireas-International Water Research Centre, University of Cyprus, P.O. Box 20537, CY-1678 Nicosia, Cyprus.
Department of Biology and CESAM, University of Aveiro, Campus Universitário Santiago, 3810-193 Aveiro, Portugal.
Karlsruhe Institute of Technology (KIT)-Campus North, Institute of Functional Interfaces (IFG), P.O. Box 3640, 76021 Karlsruhe, Germany.
Centro Nacional de Biotecnología, CSIC, Calle Darwin 3, 20049 Madrid, Spain.
Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Department of Food Safety and Infection Biology, Section of Microbiology, Immunology and Parasitology, Post Box 8146 Dep, 0033 Oslo, Norway.
Catalan Institute for Water Research (ICRA), Emili Grahit 101, 17003 Girona, Spain.
Key Laboratory of Soil Environment and Pollution Remediation, Institute of Soil Science, Chinese Academy of Sciences, Nanjing 210008, China.
Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI 48824, USA.
Center for Microbial Ecology, Department of Plant, Soil and Microbial Sciences, Michigan State University, East Lansing, MI 48824, USA.


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.

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