Antimicrobial resistance: A new threat from disinfection byproducts and disinfection of drinking water?

Antimicrobial resistance is a global threat to public health. Recent research showed that residual disinfectants and disinfection byproducts (DBPs) might play an important role in promoting antimicrobial resistant bacteria and their genetic determinates, antimicrobial resistance genes (ARGs). This review summarizes the most recent understanding of the occurrence and mechanisms involved in the antimicrobial resistance induced by DBPs and its implications in widespread of antimicrobial resistance phenomena and human health in the drinking water realm. Disinfectants and DBPs, at both above-minimum inhibitory concentrations (MICs) and sub-MICs, could induce antimicrobial resistance via genetic mutations and/or horizontal transfer of ARGs. DBP-specific mutations were identified in new genes, as well as previously recognized ARGs, and they were all related to molecular mechanisms of antibacterial resistance. Studies of individual or mixture of diverse classes of disinfectants and DBPs at environmental concentrations (usually at sub-MIC levels) need to be conducted to confirm the reported findings.