Sewage environments have been identified as risk environments for the development and transmission of antibiotic resistant bacteria. In order to reduce risks, both pre-treatment of hospital sewage as well as add-on treatment techniques at sewage treatment plants are discussed in Sweden and elsewhere. To provide guidance for the decision-making process whether, and if so where, additional treatment of sewage should be implemented regarding the risk for antibiotic resistance dissemination, this project will address the following questions; 1) Which major antibiotic resistance threats are present in treated sewage in Sweden and to what extent? 2) Are hospitals major contributors the antibiotic resistant pathogens found in municipal sewage treatment plants? 3) What are the risks for transfer of resistance factors to pathogens in municipal, hospital and treated sewage?