The impact of on-site hospital wastewater treatment on the downstream communal wastewater system in terms of antibiotics and antibiotic resistance genes

Paulus, Gabriela K.; Hornstra, Luc M.; Alygizakis, Nikiforos; Slobodnı́k, Jaroslav; Thomaidis, Nikolaos S.; Medema, Gertjan

doi:10.1016/j.ijheh.2019.01.004

Cited by 157 publications

(84 citation statements)

References 69 publications

(83 reference statements)

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“…Notably, wastewater treatment plants are usually communal facilities where the residues of the total population of a city are treated. Hospitals are the hotspots of AR in a city; hence, on-site hospital (and eventually onfarm) wastewater treatment may help to reduce the pollution of communal wastewater by antibiotics and ARBs (Cahill et al, 2019;Paulus et al, 2019), hence reducing AR transmission.…”

Section: Controlling Resistance: Local and Global Interventionsmentioning

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: Controlling Resistance: Local and Global Interventionsmentioning

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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“…Similar to the general sewage system, hospital sewage is also discharged into a public WWTP and released into rivers after primary puri cation, activated sludge process, and occasional chlorine disinfection. In recent years, technically and economically viable management strategies for ARB, ARG, and residual antibiotics discharged from hospitals have been studied in some countries [45][46][47][48][49][50][51]; however, there is a lack of similar reports from Japan. The aim of this study is to illustrate the contamination of hospital sewage with ARB containing resistant genes of clinical origin, and the effect of hospital relocation on the state of ARB/ARGs in the hospital sewage using comprehensive metagenomic sequencing.…”

Section: Introductionmentioning

confidence: 99%

Metagenomic survey and whole genome sequencing of antimicrobial resistant bacteria in the sewage of a Japanese hospital

Katagiri

Kuroda

Sekizuka

et al. 2020

Preprint

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Background The dissemination of antimicrobial-resistant bacteria (ARB) and the transfer of antimicrobial resistance genes (ARGs) are a threat to public health. Antibiotics are indispensable therapeutic agents essential for the treatment of infectious diseases; however, inappropriate use of antibiotics leads to the emergence of ARB. It is established that hospitals are closely involved in the spread of antimicrobial resistance (AMR), which impedes antibiotic treatment and subsequently increases mortality. In addition, excrement of patients or healthy carriers of ARB are discharged from the hospital sewage through the wastewater treatment plant (WWTP) into the rivers, causing an AMR burden on the environment.Method Metagenomic analysis was performed on the hospital sewage samples, followed by whole genome sequencing of the extended spectrum β-lactamase (ESBL)-producing organisms (EPOs). A comparative genome analysis was also performed between EPO isolates from sewage and clinical isolates.Results Metagenomic analysis showed that the hospital sewage tanks had bacterial flora corresponding to the human gut. During the study period, the hospital was relocated to a newly constructed building with new sewage tanks; however, the presence of ARB/ARGs in the new hospital sewage tanks became markedly equivalent to that of the old hospital within one month. The ESBL blaCTX−M and carbapenemase blaIMP genes were not much detected in the original hospital sewage samples by metagenome analysis, but selection on CHROMagar ESBL increased the sensitivity to detect those β-lactamase genes. Comparative genome analysis between sewage and clinical EPO isolates revealed partial similarity; however, most EPO isolates exhibited a notable difference (≥ 50) in single nucleotide variations based on core-genome phylogeny. This result suggests that only some of the sewage EPO isolates were originated from the clinical patient. Therapeutic agents in the hospital sewage were analyzed and the concentration of levofloxacin and clarithromycin was 0.0325 and 0.0135 µg/mL, respectively.Conclusions Whole genome analysis between sewage and clinical isolates suggested that healthy or asymptomatic carriers may be involved in the contamination of hospital sewage. Moreover, the hospital sewage tank may serve as a hotspot for the horizontal transfer of ARGs under the selective pressure of antimicrobial agents. Therefore, ARB monitoring in hospital sewage is expected to detect the presence of carriers prior to nosocomial ARB outbreaks. In addition, hospital wastewater should be treated suitably to bring ARB below detectable levels to reduce the environmental AMR burden.

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“…Several examples include using suspect screening approaches to investigate classes such as pharmaceuticals, 13,14 pesticides 15,16 or antibiotics. 17,18 Further studies are now using publicly-available suspect lists in their screening efforts. 19,20 Other early efforts include comprehensive, exploratory characterisation efforts of wastewater that went beyond compound classes.…”

Section: Introductionmentioning

confidence: 99%

Connecting environmental exposure and neurodegeneration using cheminformatics and high resolution mass spectrometry: potential and challenges

Schymanski

Baker

Williams

et al. 2019

Environ. Sci.: Processes Impacts

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The impact of on-site hospital wastewater treatment on the downstream communal wastewater system in terms of antibiotics and antibiotic resistance genes

Cited by 157 publications

References 69 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

Metagenomic survey and whole genome sequencing of antimicrobial resistant bacteria in the sewage of a Japanese hospital

Connecting environmental exposure and neurodegeneration using cheminformatics and high resolution mass spectrometry: potential and challenges

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