As antibiotics now save millions of human and animal lives annually, the World Health Organisation (WHO, 2019) declared Antibiotic Resistance (AR) as the number five most dangerous risk to global health. Several researchers mention WWTPs to be an important source for AR as the growth of bacteria is stimulated in an environment with a selective pressure facilitated by a relatively high concentration of antibiotics.

Tertiary treatment steps are implemented primary to polish the effluent and reduce the OMP load of the effluent. The O3-STEP filter is an innovative example of such a tertiary treatment combining the oxidative effects of ozone with the adsorption effects of a Granular Activated Carbon (GAC) filter. In addition to these effects, a coagulant is dosed for the removal of Phosphorus (P). The implications for AR are still unknown. In literature varying results are found on the disinfecting effects of ozone, GAC and coagulation and nothing is found on the combination of these treatment steps yet. The purpose of this document is to present how effective the treatment with ozone and coagulation is in the removal of antibiotic resistant bacteria (ARB) in comparison with antibiotic sensitive bacteria (ASB).

Agar growth media are used to test four different microorganisms: two faecal indicators (E. coli and Enterococci) and a resistant strain of each of these bacteria (ESBL E. coli and Vancomycin Resistant Enterococci (VRE)). Several experiments are conducted in the laboratory to test disinfection of ozone and coagulation on these microorganisms.

In confirmation of the hypothesis, ozonation and coagulation disinfect ARB as well as ASB. However, as both treatment steps are not aiming at the removal of microorganisms but at the removal of OMPs and phosphorus respectively, the microorganism removal is limited (with 0.7 log on average). Increasing the coagulant and ozone dosage showed promising results in the laboratory. Dosing the coagulant above the optimum sweep coagulation dosage is not favourable because the increase in removal stagnated above this concentration whilst the residual coagulant concentration in the supernatant water increased.
In the GAC of the O3-STEP filter and its backwash water, an increase of VRE is found relative to Enterococci in comparison with the ozonated water but not over the complete O3-STEP filter. This was different for the 1-STEP filter which showed the worrying result that VRE increased in the same amounts as Enterococci decreased. As the 1-STEP filter is a filter with a matured biology, where O3-STEP was recently started, the O3-STEP filter might increase the absolute and relative amount of ARB in long term as well.

In case the aim for the O3-STEP filter is to remove AR as well, several suggestions are made. As ozone and coagulation both potentially remove ARB, an increase in these concentrations is a no-regret possibility. Furthermore, ultrafiltration (UF) and the combination of ultraviolet (UV) and O3 are proposed as possible alternatives. Using a multicriteria analysis (MCA), increasing the ozone dosage with the existing bypass is recommended.