Antibiotic Resistance in Wastewater

AWARE investigates whether employees of wastewater treatment plants (WWTPs) have a higher risk of carrying resistant bacteria. The rise of antibiotic-resistant infections is an imminent global public health threat. Wastewater treatment plants are known hotspots for the dissemination of clinically relevant resistant bacteria of human origin to the environment.  AWARE started in 2017 and will run until 2020. 

Little is known about the transmission dynamics of antibiotic resistance from water, air, and soil and their risks to human health. AWARE aims to assess the health impact of exposure in and around WWTPs.


  • to study the occupational and environmental health impact of exposure to resistant bacteria and resistance genes stemming from WWTP through epidemiological studies of their carriage in WWTP workers versus unexposed controls,
  • to study human waterborne and airborne exposure through models for uptake through ingestion and inhalation,
  • to assess the efficiency of different WWTP treatment technologies,
  • to investigate selection and emergence of resistance in WWTP through studying relative changes in resistance genes and exploring putative novel resistance genes.


AWARE is coordinated by Prof.  Ana-Maria de Roda Husman, RIVM, with principal investigators from Sweden (Joakim Larsson, CARe), Germany and Romania.


AWARE is supported by the Joint Programming Initiative on Antimicrobial Resistance (JPI-AMR).