Occurrence and Risk Assessment of Antimicrobials and Resistant Bacteria in Treated Sewage Effluents in South Brazil

Background/Objectives: The increasing presence of antimicrobial residues and antibiotic-resistant bacteria (ARB) in effluents from wastewater treatment plants (WWTP) has become a critical concern for environmental and public health. This study aimed to investigate the occurrence, concentrations, and ecological risks of commonly used antimicrobials as well as the prevalence of clinically relevant ARB in treated effluents. Methods: A five-month monitoring campaign was conducted at a major WWTP in Curitiba, Brazil. Thirteen antibiotics were quantified using LC-MS/MS, resistant bacteria were identified via phenotypic profiling, and ecotoxicological assays were performed with Desmodesmus subspicatus. Risk assessments included hazard quotient (HQ) calculations for ecotoxicity and resistance selection as well as multivariate and correlation analyses. Results: All antibiotics were consistently detected over five months, with total concentrations ranging from 1730 to 2840 ng L^-1. Clinically relevant ARB (Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae) resistant to high-priority antibiotics were also isolated. Ecotoxicological tests showed moderate growth inhibition only in undiluted effluent. HQ values for ecotoxicity were <1, but HQ for resistance selection exceeded 1 for all compounds. Multivariate analyses showed strong associations between fluoroquinolone and macrolide concentrations and ARB detection. Conclusions: Although WWTPs reduce pollutant loads, conventional processes may not fully eliminate antimicrobials and ARB, highlighting the need for advanced treatments. Culture-based detection may have underestimated the resistance diversity. These findings support the integration of resistance-based discharge thresholds into regulations, and provide a replicable model for AMR surveillance in tropical urban systems.