Potential ecological and human health impacts of antibiotics and antibiotic-resistant bacteria from wastewater treatment plants

The occurrence of antibiotics and other pharmaceuticals in the environment has become an increasing public concern as recent environmental monitoring activities reveal the presence of a broad range of persistent pharmaceuticals in soil and water. Studies show that municipal wastewater treatment plants (WWTPs) are important point sources of antibiotics and antibiotic-resistant bacteria in the environment. The fate of antibiotics and other pharmaceuticals in WWTPs is greatly influenced by the design and operation of treatment systems. Because knowledge on the fate of antibiotics and resistant bacteria in WWTPs is important in estimating their potential impacts on ecology and human health, investigations on occurrence, treatment, and observed effects are reviewed in this article. In addition, human health risk assessment protocols for antibiotic and resistant bacteria are described. Although data on other pharmaceutical compounds are also presented, discussion is focused on antibiotics in the environment because of the potential link to increased emergence of resistance among pathogenic bacteria. The applications of modern analytical methods that facilitate the identification of novel transformation products of pharmaceuticals in environmental matrices are also included to illustrate that the disappearance of the parent pharmaceuticals in WWTPs does not necessarily equate to their complete removal.