The Pseudomonas aeruginosa-containing wastewater released by hospitals is treated by wastewater treatment plants (WWTPs), generating sludge, which is used as a fertilizer, and effluent, which is discharged into rivers. We evaluated the risk of dissemination of antibiotic-resistant P. aeruginosa (AR-PA) from the hospital to the environment via the wastewater network. Over a 10-week period, we sampled weekly 11 points (hospital and urban wastewater, untreated and treated water, sludge) of the wastewater network and the river upstream and downstream of the WWTP of a city in eastern France. We quantified the P. aeruginosa load by colony counting. We determined the susceptibility to 16 antibiotics of 225 isolates, which we sorted into three categories (wild-type, antibiotic-resistant and multidrug-resistant). Extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs) were identified by gene sequencing. All non-wild-type isolates (n = 56) and a similar number of wild-type isolates (n = 54) were genotyped by pulsed-field gel electrophoresis and multilocus sequence typing. Almost all the samples (105/110, 95.5%) contained P. aeruginosa, with high loads in hospital wastewater and sludge (≥3×106 CFU/l or/kg). Most of the multidrug-resistant isolates belonged to ST235, CC111 and ST395. They were found in hospital wastewater and some produced ESBLs such as PER-1 and MBLs such as IMP-29. The WWTP greatly reduced P. aeruginosa counts in effluent, but the P. aeruginosa load in the river was nonetheless higher downstream than upstream from the WWTP. We conclude that the antibiotic-resistant P. aeruginosa released by hospitals is found in the water downstream from the WWTP and in sludge, constituting a potential risk of environmental contamination.

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This study suggests that the dispatch of the guideline on urinary tract infection had a moderate impact on antibiotic prescriptions.

Infectious complications represent a major cause of morbidity and mortality in patients with organ transplantation. Contamination of preservation solution (PS) can lead to life-threatening complications in the recipients. For a 3-year period, we investigated the bacterial contamination of both PSs and graft fragments, recipient infections, and explored the link between them. In total 137 organs were transplanted, and 131 organ and perfusate cultures out of 426 tested (30.8%) gave a positive bacterial culture, mainly with coagulase-negative staphylococci. Overall, 80 recipients out of 137 (58.4%) had at least 1 infection during the 4-month post-graft surveillance period. Twelve recipients had an infection with the same bacterial species that was recovered in the corresponding graft. However, based on pulsed-field gel electrophoresis typing results, only 1 case was very likely cross-transmitted via the transplantation.

Level III: case control study.

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