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Providing safe water through water reuse is becoming a global necessity. One concern with water reuse is the introduction of unregulated contaminants to the environment that cannot be easily removed by conventional wastewater treatment plants (WWTP). The occurrence of ampicillin, sulfamethoxazole, ciprofloxacin, and tetracycline-resistant Escherichia coli through the treatment stages of a WWTP (raw sewage, post-secondary, post-UV and post-chlorination) was investigated from January to May 2016. The highest concentrations of antibiotic resistant E. coli in the effluent were detected in April after rainfall. Ampicillin-resistant E. coli was the most common at the post UV and chlorination stages comprising 63% of the total E. coli population. The minimum inhibitory concentration (MIC) analysis showed that one in five isolates was resistant to three or more antibiotics, and the majority of these E. coli were resistant to ampicillin, followed by sulfamethoxazole and ciprofloxacin. The highest MIC was detected at the finished water after application of multiple disinfection methods. Tetracycline resistance was the least observed among others, indicating that certain drug families may respond to wastewater treatment differently. Currently, there are no policies to enforce the monitoring of antibiotic-resistant pathogen removal in WWTP. Better guidelines are needed to better regulate reuse water and prevent health risk upon exposure to antibiotic-resistant bacteria.


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