| Summary: | Wastewater treatment plants are efficient in reducing bacterial loads but are also considered potential drivers of environmental antimicrobial resistance (AMR). In this study, we determined the effect of increased influent wastewater volume (from 40% to 66%) in the Legon sewage treatment plant (STP) on the removal of <i>E. coli</i> from sewage, along with changes in AMR profiles. This before and after study compared <i>E. coli</i> loads and AMR patterns in influent and effluent samples from a published baseline study (January–June 2018) with a follow-up study (March–May 2023). Extended-spectrum beta-lactamase (ESBL) <i>E. coli</i> were measured pre- and post-sewage treatment during the follow-up study. The follow-up study showed 7.4% and 24% ESBL <i>E. coli</i> proportions in influent and effluent, respectively. In both studies, the STP was 99% efficient in reducing <i>E. coli</i> loads in effluents, with no significant difference (<i>p</i> = 0.42) between the two periods. More <i>E. coli</i> resistance to antimicrobials was seen in effluents in the follow-up study versus the baseline study. The increased influent capacity did not reduce the efficiency of the STP in removing <i>E. coli</i> from influent wastewater but was associated with increased AMR patterns in effluent water. Further studies are required to determine whether these changes have significant effects on human health.
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