Antimicrobial resistance (AMR) is a major threat to global health. Understanding the emergence, evolution, and transmission of individual antibiotic resistance genes (ARGs) is essential to develop sustainable strategies combatting this threat. Here, we use metagenomic sequencing to analyse ARGs in 757 sewage samples from 243 cities in 101 countries, collected from 2016 to 2019. We find regional patterns in resistomes, and these differ between subsets corresponding to drug classes and are partly driven by taxonomic variation. The genetic environments of 49 common ARGs are highly diverse, with most common ARGs carried by multiple distinct genomic contexts globally and sometimes on plasmids. Analysis of flanking sequence revealed ARG-specific patterns of dispersal limitation and global transmission. Our data furthermore suggest certain geographies are more prone to transmission events and should receive additional attention.

Water retention times less than 3 h from inlet to outlet were necessary to meet new effluent requirements without extending the footprint of the existing plant. Nitrogen removal was required at the existing, high loaded, direct precipitation plant and space was not readily available. The staff at the VEAS WWTP took on the task to design a new process at their own risk. Selected solutions and ups and downs in the water treatment during the past 10 years of operations and further developments are presented in this paper. Always asking for well-proven solutions might make life easy. The intent of this paper is to encourage some of our colleagues to be more daring in their approach to new challenges. However, expect sleepless nights in order to solve the unexpected problems along the way.

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