Environmental fate of pharmaceutical compounds and antimicrobial-resistant bacteria in hospital effluents, and contributions to pollutant loads in the surface waters in Japan

Azuma, Takashi; Otomo, Kana; Kunitou, Mari; Shimizu, Mai; Hosomaru, Kaori; Mikata, Shiori; Ishida, Mao; Hisamatsu, Kanae; Yunoki, Ayami; Mino, Yoshiki; Hayashi, Tetsuya

doi:10.1016/j.scitotenv.2018.11.433

Cited by 108 publications

(66 citation statements)

References 76 publications

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“…While the direct selection of AR by antibiotics or the coselection mediated by other pollutants, as the aforementioned heavy metals, has been discussed (Wales and Davies, 2015), the effect of other types of human interventions on the dissemination of ARGs and ARBs through natural ecosystems has been analyzed in less detail. As an example, it has been proposed that wastewater treatment plants, where commensals, ARBs, ARGs, and antibiotics coexist, could act as bioreactors favoring the selection and transmission of ARGs between different organisms (Rizzo et al, 2013;Su et al, 2017;Manaia et al, 2018), although evidences supporting this statement are scarce (Munck et al, 2015;Azuma et al, 2019).…”

Section: Antibiotic Resistance In An Anthropogenically Impacted Worldmentioning

confidence: 99%

Antibiotic Resistance: Moving From Individual Health Norms to Social Norms in One Health and Global Health

et al. 2020

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Antibiotic resistance is a problem for human health, and consequently, its study had been traditionally focused toward its impact for the success of treating human infections in individual patients (individual health). Nevertheless, antibiotic-resistant bacteria and antibiotic resistance genes are not confined only to the infected patients. It is now generally accepted that the problem goes beyond humans, hospitals, or long-term facility settings and that it should be considered simultaneously in human-connected animals, farms, food, water, and natural ecosystems. In this regard, the health of humans, animals, and local antibiotic-resistance-polluted environments should influence the health of the whole interconnected local ecosystem (One Health). In addition, antibiotic resistance is also a global problem; any resistant microorganism (and its antibiotic resistance genes) could be distributed worldwide. Consequently, antibiotic resistance is a pandemic that requires Global Health solutions. Social norms, imposing individual and group behavior that favor global human health and in accordance with the increasingly collective awareness of the lack of human alienation from nature, will positively influence these solutions. In this regard, the problem of antibiotic resistance should be understood within the framework of socioeconomic and ecological efforts to ensure the sustainability of human development and the associated human-natural ecosystem interactions.

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Section: Antibiotic Resistance In An Anthropogenically Impacted Worldmentioning

confidence: 99%

Antibiotic Resistance: Moving From Individual Health Norms to Social Norms in One Health and Global Health

et al. 2020

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“…Previous studies have also reported the isolation of CPB from water samples of rivers in different countries, such as KPC-2-producing C. freundii in China [24], OXA-48-like-producing Escherichia coli and Klebsiella pneumoniae in Algeria [25], and NDM-9-producing Klebsiella variicola in South Korea [26]. Studies by Azuma et al and Khan et al highlighted the dissemination of clinically significant ARB from hospitals into the receiving water bodies [27,28]. However, very limited studies have been conducted concerning the diversity and prevalence of ARGs and ARB in hospital sewage systems and receiving waters in China.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence and Characterization of Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Bacteria from Hospital Sewage, Treated Effluents and Receiving Rivers

Zhang

Luo

et al. 2020

IJERPH

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Hospital sewage plays a key role in the dissemination of antibiotic-resistant genes (ARGs) by serving as an environmental antimicrobial resistance reservoir. In this study, we aimed to characterize the cephalosporin- and carbapenem-resistant isolates from hospital sewage and receiving rivers. The results showed that ESBL (blaCTX-M) and carbapenemase genes (blaNDM and blaKPC) were widely detected in a number of different bacterial species. These resistance genes were mainly harbored in Enterobacteriaceae, followed by Acinetobacter and Aeromonas isolates. More attention should be given to these bacteria as important vectors of ARGs in the environment. Furthermore, we showed that the multidrug resistance phenotype was highly prevalent, which was found in 85.5% Enterobacteriaceae and 75% Acinetobacter strains. Notably, the presence of carbapenemase genes in isolates from treated effluents and receiving rivers indicates that the discharges of wastewater treatment plants could be an important source for high-risk resistance genes propagation to the environment. In conclusion, this study shows a high prevalence of ESBL- and carbapenemase-producing bacteria in hospital sewage and receiving rivers in China. These findings have serious implications for human health, and also suggest the need for more efforts to control the dissemination of resistant bacteria from hospital sewage into the environment.

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“…The main route of ARG dissemination may switch from active transmission, which is dominated by antibiotics, to passive transmission, which is motivated and affected by non-corresponding contaminants [30]. In fact, Azuma et al reported the concentration of pharmaceutical compounds (PhCs) in the Japanese environment and demonstrated 48 PhCs in the range of 1 ng/L (losartan carboxylic acid) to 228 µg/L (acetaminophen sulfate) in hospital e uent, and the contribution of the pollution load derived from hospital e uent to WWTP in uent was estimated as 0.1-15% [31].…”

Section: Discussionmentioning

confidence: 99%

Characterization of urban wastewater treatment plant effluent from Tokyo using metagenomics and β-lactam-resistant Enterobacteriaceae isolates

Sekizuka¹,

Itokawa²,

Tanaka³

et al. 2020

Preprint

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Background: The World Health Organization has endorsed a global action plan on antimicrobial resistance (AMR), which calls upon all nations to adopt mitigation strategies based on the one-health approach. In particular, environmental factors to evaluate their potential risk for promoting the evolution of AMR have not been sufficiently characterized, yet. Instead of the limited nosocomial AMR surveillance, sewage AMR surveillance could highlight a broader picture of the global burden of AMR, including local-specific features, such as urban-, suburban-, industrial-, or agricultural-based, based on the One-Health approach.Methods: We characterized environmental AMR burden in effluents of eight wastewater treatment plants (WWTPs) around the Tama River and Tokyo Bay by metagenomic analysis of AMR genes (ARGs) and heavy metal resistance genes and whole-genome sequencing of AMR bacteria (ARB) isolates.Results: We found that seasonal features of ARGs eluted from WWTPs and sul1 and qacE (or qacE∆1), which are the main contributors of class 1 integron, were rich genetic factors as baseline ARG pollutants. In addition, aadA6 and msr(E) were predominant ARGs against aminoglycoside and macrolide resistance, respectively. Among the detected ARB isolates, complete genome sequencing demonstrated that E. coli O16:H5-ST131-fimH41 producing CTX-M-27 exhibited marked genome clonality with clinical isolates from several countries. Complete plasmid sequences highlighted that ARG distribution was involved in plasmid replicon and its bacterial hosts.Conclusions: Here, we provide a baseline for investigating environmental AMR dissemination and the possibility of using metagenomics for comprehensive AMR surveillance in sewage. This study demonstrated that AMR monitoring could uncover the actual status of the effluents from WWTP and would suggest how we should conduct further studies to reduce the related AMR burden to prevent it from becoming a potential health risk.

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Environmental fate of pharmaceutical compounds and antimicrobial-resistant bacteria in hospital effluents, and contributions to pollutant loads in the surface waters in Japan

Cited by 108 publications

References 76 publications

Antibiotic Resistance: Moving From Individual Health Norms to Social Norms in One Health and Global Health

Antibiotic Resistance: Moving From Individual Health Norms to Social Norms in One Health and Global Health

The Prevalence and Characterization of Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Bacteria from Hospital Sewage, Treated Effluents and Receiving Rivers

Characterization of urban wastewater treatment plant effluent from Tokyo using metagenomics and β-lactam-resistant Enterobacteriaceae isolates

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