Antibiotics and antibiotic-resistant bacteria in waters associated with a hospital in Ujjain, India

Abstract

BackgroundConcerns have been raised about the public health implications of the presence of antibiotic residues in the aquatic environment and their effect on the development of bacterial resistance. While there is information on antibiotic residue levels in hospital effluent from some other countries, information on antibiotic residue levels in effluent from Indian hospitals is not available. Also, concurrent studies on antibiotic prescription quantity in a hospital and antibiotic residue levels and resistant bacteria in the effluent of the same hospital are few. Therefore, we quantified antibiotic residues in waters associated with a hospital in India and assessed their association, if any, with quantities of antibiotic prescribed in the hospital and the susceptibility of Escherichia coli found in the hospital effluent.MethodsThis cross-sectional study was conducted in a teaching hospital outside the city of Ujjain in India. Seven antibiotics - amoxicillin, ceftriaxone, amikacin, ofloxacin, ciprofloxacin, norfloxacin and levofloxacin - were selected. Prescribed quantities were obtained from hospital records. The samples of the hospital associated water were analysed for the above mentioned antibiotics using well developed and validated liquid chromatography/tandem mass spectrometry technique after selectively isolating the analytes from the matrix using solid phase extraction. Escherichia coli isolates from these waters were tested for antibiotic susceptibility, by standard Kirby Bauer disc diffusion method using Clinical and Laboratory Standard Institute breakpoints.ResultsCiprofloxacin was the highest prescribed antibiotic in the hospital and its residue levels in the hospital wastewater were also the highest. In samples of the municipal water supply and the groundwater, no antibiotics were detected. There was a positive correlation between the quantity of antibiotics prescribed in the hospital and antibiotic residue levels in the hospital wastewater. Wastewater samples collected in the afternoon contained both a higher number and higher levels of antibiotics compared to samples collected in the morning hours. No amikacin was found in the wastewater, but E.coli isolates from all wastewater samples were resistant to amikacin. Although ciprofloxacin was the most prevalent antibiotic detected in the wastewater, E.coli was not resistant to it.ConclusionsAntibiotics are entering the aquatic environment of countries like India through hospital effluent. In-depth studies are needed to establish the correlation, if any, between the quantities of antibiotics prescribed in hospitals and the levels of antibiotic residues found in hospital effluent. Further, the effect of this on the development of bacterial resistance in the environment and its subsequent public health impact need thorough assessment.

Characteristics of ciprofloxacin-resistant Enterobacteriaceae isolates recovered from wastewater of an Algerian hospital

“…In addition, three plasmidic resistance gene classes have been described, which encode proteins of protection of the target (qnr), acetylation of antibiotic (aac(6')Ib-cr), and specific efflux (qepA and oqxAB). A worldwide constant increase in bacterial resistance to quinolones was observed during the last decade, inherent to the massive use of antibiotics in human therapy and in intensive livestock, particularly poultry, in some countries [1,2]. Hospital effluents discharged into the sewer system, usually without pre-treatment, have been reported to be an influent source of antimicrobial residues and antibiotic-resistant bacteria to the wastewater treatment plant (WWTP) [3].…”

“…For this purpose, we proposed, in this study, to characterize the ciprofloxacin resistance in Enterobacteriaceae isolates collected from the wastewater of a hospital in Algiers. Ciprofloxacin is the only quinolone prescribed in Algeria, the one prescribed most widely in the world, and also the one most frequently detected in surface waters, especially in hospital effluents [1,3,4].…”

Antibiotic Resistant Bacteria from Treated and Untreated Hospital Wastewater at Ayder Referral Hospital, Mekelle, North Ethiopia

“…The most common bacterial pathogens found in hospital wastewater are Salmonella, Shigella, S. aureus, P. aeruginosa, Vibrio, Clostridium, Yersinia, Campylobacter, Leptospira and groups of total coliforms consisting of Serratia, Enterobacter, Klebsiella, and Escherichia coli (E. coli) [8] [9]. Those bacterial pathogens are among of the most dangerous contaminants on human health, and then the effluents from hospital wastewaters are one of the most serious pollutants discharging to the environment [9] [10]. The multidrug resistance patterns seen in the bacterial isolates from hospital effluent samples include most of the antibiotics used presently for treating human infections.…”

Antibiotic resistance and genetic diversity in water-borne Enterobacteriaceae isolates from recreational and drinking water sources

“…It has also been presumed that much of the hospital/industrial/ domestic wastewater does not undergo effective treatment that permits low concentration of antibiotics finding way into water bodies like rivers, lakes, reservoirs, etc. This exposure over period of time provides ideal conditions for transfer of antibiotic resistance (Diwan et al 2010).…”