Reusing treated wastewater: Consideration of the safety aspects associated with antibiotic-resistant bacteria and antibiotic resistance genes

Pei Ying Hong*, Timothy R. Julian, Marie Laure Pype, Sunny C. Jiang, Kara L. Nelson, David Graham, Amy Pruden, Célia M. Manaia

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

70 Scopus citations


As more countries engage in water reuse, either intended or de facto, there is an urgent need to more comprehensively evaluate resulting environmental and public health concerns. While antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) are increasingly coming under the spotlight, as emerging contaminants, existing water reuse regulations and guidelines do not adequately address these concerns. This perspectives paper seeks to frame the various challenges that need to be resolved to identify meaningful and realistic target types and levels of antibiotic resistance benchmarks for water reuse. First, there is the need for standardized and agreed-upon methodologies to identify and quantify ARB and ARGs. Second, even if methodologies are available, identifying which ARB and ARGs to monitor that would best relate to the occurrence of disease burden remains unknown. Third, a framework tailored to assessing the risks associated with ARB and ARGs during reuse is urgently needed. Fourth, similar to protecting drinking water sources, strategies to prevent dissemination of ARB and ARGs via wastewater treatment and reuse are required to ensure that appropriate barriers are emplaced. Finally, current wastewater treatment technologies could benefit from modification or retrofit to more effectively remove ARB and ARGs while also producing a high quality product for water and resource recovery. This perspectives paper highlights the need to consider ARB and ARGs when evaluating the overall safety aspects of water reuse and ways by which this may be accomplished.

Original languageEnglish (US)
Article number244
JournalWater (Switzerland)
Issue number3
StatePublished - Feb 27 2018

Bibliographical note

Funding Information:
wastewater treatment—from waste to resource” held on 27–29 March 2017. The conference was sponsored by KAUST Office of Sponsored Research (OSR) and was organized by Water Desalination and Reuse Center (WDRC).

Publisher Copyright:
© 2018 by the authors.


  • Monitoring and surveillance
  • Risk assessment
  • Source prevention
  • Wastewater treatment
  • Water reuse

ASJC Scopus subject areas

  • Geography, Planning and Development
  • Biochemistry
  • Aquatic Science
  • Water Science and Technology


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