What role does the sanitation sector play in the fight against antibiotic resistance?

Due to the massive use of antibiotics, antimicrobial resistance (ABR) continues to spread, endangering disease control worldwide and the quality of the environment. The sources of emissions of bacteria or antimicrobial resistance genes are linked to human activities: urban, hospital, industrial, livestock releases. The role played by sanitation systems - network, wastewater treatment lines (STEU) and sludge treatment in the problem of ABR has not yet been clearly established by the scientific community. The data available to date show that WWTPs eliminate some of the bacteria, genes and antibiotics, although this is not their primary purpose. They thus play an important filter role to limit dissemination in the environment. But conversely, some authors warn against their potential involvement in the selection of new resistant germs, given the conditions favorable to the exchange of genetic material between microbial strains of diverse natures exposed to selective agents. Today, knowledge on the mechanisms involved in the selection of ABR and the fate of bacteria and resistance genes within sanitation systems remains limited. Research work is necessary to better characterize their contribution and evaluate the performance of wastewater, recycled water, rainwater and sludge treatment processes.