What happens in hospitals does not stay in hospitals: antibiotic-resistant bacteria in hospital wastewater systems

Hocquet, Didier; Muller, Allison; Bertrand, Xavier

doi:10.1016/j.jhin.2016.01.010

Cited by 263 publications

(195 citation statements)

References 46 publications

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“…All samples tested positive for E. coli and ESBLEC (see Table S1 in the supplemental material for concentrations of total E. coli and ESBLEC CFU in each sample). The average proportion of ESBLEC CFU among total E. coli CFU was 4.2% (minimum, 2.3%; maximum, 9.3%) for the WWTP samples, which is relatively high compared to previous studies (0.4% to 2.3%) (7). Conversely, the average proportion was 3.5% (minimum, 0.2%; maximum, 11.3%) for the hospital wastewater, and this value is relatively low compared to previous studies (3.8% to 13.6%) (7).…”

Section: Resultscontrasting

confidence: 58%

“…Therefore, wastewater treatment plants (WWTPs) and hospitals are considered to be major sources of ESBLEC released into the environment (5). In fact, the presence of ESBLEC in hospital wastewater and the inflow and outflow of WWTPs has been well documented in previous studies (6)(7)(8). However, data are limited with respect to detailed genetic characteristics of ESBLEC in wastewater.…”

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confidence: 99%

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Occurrence of Clinically Important Lineages, Including the Sequence Type 131 C1-M27 Subclone, among Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Wastewater

Gomi

Matsuda

Matsumura

et al. 2017

Antimicrob Agents Chemother

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Contamination of environmental waters by extended-spectrum-␤-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is of great concern. Wastewater treatment plants (WWTPs) and hospitals release large amounts of ESBLEC into the environment. In the present study, we isolated ESBLEC strains from wastewater collected from a WWTP and a hospital in Japan and performed whole-genome sequencing to characterize these strains. Genomic analysis of 54 strains (32 from the WWTP and 22 from hospital wastewater) revealed the occurrence of clinically important clonal groups with extraintestinal pathogenic E. coli status in the WWTP and hospital wastewater. Fine-scale phylogenetic analysis was performed to further characterize 15 sequence type 131 (ST131) complex strains (11 from the WWTP and 4 from hospital wastewater). These ST131 complex strains were comprised of the following different subgroups: clade A (n ϭ 2), C1-M27 (n ϭ 8), and C1 (non-C1-M27) (n ϭ 1) for strains from the WWTP and clade A (n ϭ 2), C1-M27 (n ϭ 1), and C1 (non-C1-M27) (n ϭ 1) for strains from hospital wastewater. The results indicate that ESBLEC strains belonging to clinically important lineages, including the C1-M27 clade, may disseminate into the environment through wastewater, highlighting the need to monitor for antibiotic resistance in wastewater.

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Section: Resultscontrasting

confidence: 58%

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confidence: 99%

Occurrence of Clinically Important Lineages, Including the Sequence Type 131 C1-M27 Subclone, among Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Wastewater

Gomi

Matsuda

Matsumura

et al. 2017

Antimicrob Agents Chemother

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“…Although antibiotic resistance was initially thought to have evolved in the clinical setting, much more attention is now being directed towards understanding the ecological and environmental factors contributing to resistance gene acquisition among microorganisms. While some studies have attempted to highlight the dissemination of resistance genes between environmental and pathogenic bacteria [65,66], the complexity of the processes and the relative scarcity of information on this subject indicate a dearth of adequate knowledge in this field. This study revealed the presence of nine out of the 10 genes assayed conferring resistance against the various classes of drugs used in treating Vibriosis and other infections caused by Vibrio species.…”

Section: Discussionmentioning

confidence: 99%

Ecological and Public Health Implications of the Discharge of Multidrug-Resistant Bacteria and Physicochemical Contaminants from Treated Wastewater Effluents in the Eastern Cape, South Africa

Adefisoye

Okoh

2017

Water

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This study assessed the prevalence of fecal indicator bacteria (FIB) and Vibrio species, as well as the physicochemical qualities of the discharged effluents of two wastewater treatment facilities, in the Eastern Cape, South Africa over a one-year sampling period using standard methods. Bacteriological assessment revealed presumptive E. coli counts ranging from 3 to 1.2 × 10 5 CFU/100 mL, while counts of Vibrio spp. ranged from 11 to 1.4 × 10 4 CFU/100 mL. Molecular identification of the isolates by polymerase chain reactions (PCR) yielded positive reaction rates of 76.2% (381/500) and 69.8% (279/400) for E. coli and Vibrio species, respectively. The antibiotic susceptibility profiles of 205 randomly selected PCR-confirmed Vibrio isolates against 18 antibiotics revealed resistance frequencies ranging from 0.5% (imipenem) to 96.1% (penicillin G), based on recommended breakpoint concentrations. About 81% (166/205) of the Vibrio isolates exhibited multidrug resistance (resistance to three or more classes of antibiotics), while nine different antibiotic resistance genes were detected by PCR. The physicochemical qualities of the effluents also ranged as follows: pH (6.5-7.6), temperature (12-27 • C), turbidity (1.5-65.7 mg/L), total dissolved solids (95-171 mg/L), dissolved oxygen (2.1-9.8), electrical conductivity (134-267 µS/cm), free chlorine (0.08-0.72 mg/L), biochemical oxygen demand (0.12-9.81 mg/L), nitrate (1.04-21.5 mg/L), nitrite (0.11-0.76 mg/L), phosphate (1.03-18.3 mg/L) and chemical oxygen demand (27-680 mg/L). The discharged effluents fell short of the regulatory guidelines for some of the parameters assessed. We conclude that the discharged effluents are potential sources of environmental pollution and can contribute to drug resistant bacteria load in the receiving watershed, with the associated ecological and human health risks.

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“…Hospital wastewater, which receives high loads of antimicrobial agents and human pathogens, is considered a reservoir for antibiotic resistance and other genetic factors which promote the potential spread of AMR to the environment (30,31). In attempt to control this critical point, this surveillance study aimed at obtaining an in-depth characterization of AMR in hospital wastewater in Singapore by quantifying the presence of antibiotic resistance factors, including antibiotic residues, resistant bacteria, and genetic determinants (i.e., ARGs, integron) in hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

Occurrences and Characterization of Antibiotic-Resistant Bacteria and Genetic Determinants of Hospital Wastewater in a Tropical Country

Chen

et al. 2016

Antimicrob Agents Chemother

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e Wastewater discharged from clinical isolation and general wards at two hospitals in Singapore was examined to determine the emerging trends of antibiotic resistance (AR). We quantified the concentrations of 12 antibiotic compounds by analysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS), antibiotic-resistant bacteria (ARB), the class 1 integrase gene (intI1), and 16 antibiotic resistance genes (ARGs) that confer resistance to 10 different clinically relevant antibiotics. A subset of 119 antibiotic-resistant isolates were phylogenetically classified and tested for the presence of ARGs encoding resistance to ␤-lactam antibiotics (bla NDM , bla KPC , bla SHV , bla CTX-M ), amikacin [aac(6=)-Ib], co-trimoxazole (sul1, sul2, dfrA), ciprofloxacin (qnrA, qnrB), and the intI1 gene. Among these resistant isolates, 80.7% were detected with intI1 and 66.4% were found to carry at least 1 of the tested ARGs. Among 3 sampled locations, the clinical isolation ward had the highest concentrations of ARB and the highest levels of ARGs linked to resistance to ␤-lactam (bla KPC ), co-trimoxazole (sul1, sul2, dfrA), amikacin [aac(6=)-Ib], ciprofloxacin (qnrA), and intI1. We found strong positive correlations (P < 0.05) between concentrations of bacteria resistant to meropenem, ceftazidime, amikacin, co-trimoxazole, and ciprofloxacin and abundances of bla KPC , aac(6=)-Ib, sul1, sul2, dfrA, qnrA, and intI1 genes.

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What happens in hospitals does not stay in hospitals: antibiotic-resistant bacteria in hospital wastewater systems

Cited by 263 publications

References 46 publications

Occurrence of Clinically Important Lineages, Including the Sequence Type 131 C1-M27 Subclone, among Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Wastewater

Occurrence of Clinically Important Lineages, Including the Sequence Type 131 C1-M27 Subclone, among Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Wastewater

Ecological and Public Health Implications of the Discharge of Multidrug-Resistant Bacteria and Physicochemical Contaminants from Treated Wastewater Effluents in the Eastern Cape, South Africa

Occurrences and Characterization of Antibiotic-Resistant Bacteria and Genetic Determinants of Hospital Wastewater in a Tropical Country

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