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Antibiotic resistance is one of the biggest challenges to public health and ecological safety in the 21st century. Urban wastewater treatment plants (UWTPs), as reservoirs of antibiotic resistance genes (ARGs) and antibiotic-resistant bacteria (ARB), simultaneously contain a wide variety of chemical pollutants. The review introduces the actual concentration levels and the mechanisms of antibiotic resistance drivers (ARDs) in UWTPs, including antibiotics, heavy metals, disinfectants, cosmetics and personal care products, non-antibiotic drugs, and microplastics. Moreover, this review emphasizes the importance of approaching the actual activated sludge environment in future research and proposes future directions.