Performance of full-scale rural wastewater treatment plants in the reduction of antibiotic-resistant bacteria and antibiotic resistance genes from small-city effluents

The main objective of this study was to evaluate the performance of full-scale rural wastewater treatment plants (WWTPs) in the reduction of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) from small-city effluents. Twenty full-scale WWTPs in rural Chile with different biological treatment technologies (vermifiltration (VF), activated sludge (AS) and biodisc (BD)) and disinfection treatments (chlorination (Cl) and UV irradiation (UV)) were monitored and studied in two campaigns: Campaign 1 (20 WWTPs) and Campaign 2 (6 WWTPs). In both campaigns, the rural WWTPs improved the water quality of the effluents very significantly (90%, 70%, and 40% reductions in TU, COD, and NH4+-N, respectively) and reduced ARB and ARG loads by 2 to 4log units. All three biological treatments contributed to the final quality of the effluents, especially in terms of microbiological parameters, with statistically indistinguishable efficiencies between them. These results show the importance of rural WWTPs in improving the water quality of urban effluents while reducing microbiological risk and the spread of antibiotic resistance into the environment. The study demonstrates the utility of a non-centralized, self-managed wastewater treatment scheme that can be implemented in many sparsely populated areas around the world.