Wastewater Resistance Dynamics: Antibiotic–Disinfectant Interaction Patterns, Surveillance, and Emerging Containment Strategies

Abstract

Globally, antimicrobials are indispensable components of modern healthcare, sanitation, and water management systems; consequently, their contamination levels in the environment are burgeoning, thereby exacerbating a global health crisis. In addition, antimicrobial residues in the environment exert selective pressure that fosters the emergence and dissemination of resistant pathogens, including co- and cross-resistance between antibiotics and disinfectants, which intensifies public health threat. Wastewater has been identified as the dominant environmental pathway, providing conditions that allow for resistant bacteria and resistance genes to persist and interact. Conventional treatment processes reduce microbial loads but are far less effective against resistance determinants, leaving a reservoir of genetic material that sustains antimicrobial resistance. This underscores the need for advanced treatment technologies capable of eliminating both the resistant organisms and resistance genes. Equally critical is precise detection, where novel molecular tools can generate reliable estimates of resistance prevalence and coselection dynamics. This review highlights key knowledge gaps: limited efficacy of current detection and control strategies, insufficient attention to coresistance, and the absence of standardized frameworks for evaluating antimicrobial resistance removal in wastewater. Addressing these gaps is essential to scale up laboratory findings into practical applications and to inform interventions, guided by surveillance insights that mitigate coresistance to antibiotics and disinfectants.