Antibiotic resistance and antibiotic-resistance genes of Pseudomonas spp. and Escherichia coli isolated from untreated hospital wastewater

Hospital wastewater (HWW) treatment in low- and middle-income countries: A systematic review of microbial treatment efficacy

BACKGROUND

Proper treatment of hospital wastewater (HWW) is crucial to minimize the long-term effects on human health and aquatic ecosystems. However, the majority of HWW generated in low and middle-income countries (LMICs), is discharged without adequate treatment. This systematic review aims to fill the knowledge gap in LMICs by examining the efficacy of HWW treatment and the types of technologies used.

METHODS

Studies included in the review offered valuable insights into the current state of HWW management in LMICs. Between 2000 and 2022, only 36 research studies focused on hospital-based wastewater treatment within LMICs. Data were extracted on wastewater treatment technologies in hospitals or healthcare settings in LMICs. Data on sampling techniques, effectiveness, microorganisms and risk of bias of included studies were recorded.

RESULTS

A total of 36 articles met the eligibility criteria: mentioned about 1) hospitals 2) wastewater treatment 3) LMICs and 4) treatment efficacy. Twenty-two studies were conducted in Asia (22/36), 17 were conducted in countries with high Human Development Index. Constructed wetland, and activated sludge process were the most common technologies used in LMICs. A few studies utilized membrane bioreactors and ozone/UV treatment. Fourteen studies reported the concentration reduction to assess the microbial efficacy of the treatment process, 29/36 studies did not meet the national standards for effluent discharge. Reporting on sampling methods, wastewater treatment processes and efficacy of HWW treatment were at high risk of bias. Extreme heterogeneity in study methods and outcomes reporting precluded meta-analysis.

CONCLUSIONS

The existing evidence indicates inadequate microbial treatment in low- and middle-income country hospitals, with this systematic review emphasizing the need for improvement in healthcare waste management. It underscores the importance of long-term studies using innovative treatment methods to better understand waste removal in LMIC hospitals and calls for further research to develop context-specific healthcare waste treatment approaches in these regions.

Synergistic effects of layered Ti3C2TX MXene/MIL-101(Cr) heterostructure as a sonocatalyst for efficient degradation of sulfadiazine and acetaminophen in water

In this work, different mass loadings of MXene-coupled MIL-101(Cr) (MXe/MIL-101(Cr)) nanocomposites were generated through a hydrothermal process in order to investigate the potential of this nanocomposite as a novel sonocatalyst for the elimination of sulfadiazine (SD) and acetaminophen (AAP) in aqueous media. The sonocatalytic activity of different MXe/MIL-101(Cr) compositions and surface functionalities was investigated. In addition, the sonocatalytic activities at various pH values, temperatures, pollutant concentrations, catalyst dosages, initial H2O2 concentrations, and organic matter contents were investigated. The experiments on the sonocatalytic elimination of SD and AAP revealed that MXe/MIL-101(Cr) exhibited a catalytic efficiency of ∼ 98% in 80 min when the MXene loading was 30 wt% in the nanocomposite. Under optimized reaction conditions, the degradation efficiency of MXe/MIL-101(Cr) reached 91.5% for SD and 90.6% for AAP in 60 min; these values were 1.2 and 1.8 times greater than those of MXene and MIL-101(Cr), respectively. The high surface area of the MXe/MIL-101(Cr) nanocomposite increased from 4.68 m2/g to 294.21 m2/g, and the band gap of the tagged MIL-101(Cr) on the MXene surface was minimized. The superior sonocatalytic activity of MXe/MIL-101(Cr) was attributed to the effective contact interface, the effective separation rate of e- - h+ pairs through the type II heterostructure interface, and the favorable high free •OH radical production rates that promoted the degradation of SD and AAP. The solid heterointerface between MIL-101(Cr) and MXene was confirmed through Raman and FTIR analysis and was found to promote accessible •OH radical production under sonication, thus maximizing the catalytic activity of nanocomposites. The present results present an effective strategy for the design of a highly efficient, low-cost, reliable sonocatalyst that can eradicate pharmaceutical pollutants in our environment.

Optimizing ozone dose and contact time for removal of antibiotic-resistant P. aeruginosa, A. baumannii, E. coli, and associated resistant genes in effluent of an activated sludge process in a municipal WWTP

This study aimed to investigate the impact of ozonation on inactivation of antibiotic-resistant bacteria (ARB) including E. coli, P. aeruginosa, and A. baumannii, as well as on removal of 16S-rRNA gene and their associated antibiotic-resistant genes (ARGs) indigenously present in effluent of municipal wastewater treatment plant. The Chick-Watson model was used to describe bacterial inactivation rates at specific ozone doses. Maximum reduction of total cultivable A. baumannii, E. coli, and P. aeruginosa were found to be 7.6, 7.1, and 4.7 log, respectively, with the highest ozone dose of 0.48 gO₃/gCOD at 12 min contact time. According to the study results, complete inactivation of ARB and bacterial regrowth was not observed after 72 h incubation. The culture methods overestimated the performance of disinfection processes and propidium monoazide combined with qPCR, and showed the presence of viable but non-culturable bacteria after ozonation. ARGs were more persistent to ozone than ARB. The results of this study highlighted the significance of specific ozone dose and contact time in ozonation process considering the bacterial species and associated ARGs as well as the wastewater physicochemical characteristics, in order to help diminish the entrance of the biological microcontaminants into the environment.

The spread of antibiotic resistance to humans and potential protection strategies

Antibiotic resistance is currently one of the greatest threats to human health. Widespread use and residues of antibiotics in humans, animals, and the environment can exert selective pressure on antibiotic resistance bacteria (ARB) and antibiotic resistance gene (ARG), accelerating the flow of antibiotic resistance. As ARG spreads to the population, the burden of antibiotic resistance in humans increases, which may have potential health effects on people. Therefore, it is critical to mitigate the spread of antibiotic resistance to humans and reduce the load of antibiotic resistance in humans. This review briefly described the information of global antibiotic consumption information and national action plans (NAPs) to combat antibiotic resistance and provided a set of feasible control strategies for the transmission of ARB and ARG to humans in three areas including (a) Reducing the colonization capacity of exogenous ARB, (b) Enhancing human colonization resistance and mitigating the horizontal gene transfer (HGT) of ARG, (c) Reversing ARB antibiotic resistance. With the hope of achieving interdisciplinary one-health prevention and control of bacterial resistance.

Review of hospital effluents: special emphasis on characterization, impact, and treatment of pollutants and antibiotic resistance

Health care institutions generate large volumes of liquid effluents from specific activities related to healthcare, analysis, and research. Their direct discharge into the environment has various negative effects on aquatic environments and human health, due to their high organic matter charges and the presence of various emerging contaminants such as disinfectants, drugs, bacteria, viruses, and parasites. Moreover, hospital effluents, by carrying antibiotics, contribute to the development of antibiotic-resistant microorganisms in the environment. This resistance has become a global issue that manifests itself variously in different countries, causing the transmission of different infections. In this respect, an effort is provided to protect water resources by current treatment methods that imply physical-chemical processes such as adsorption and advanced oxidation processes, biological processes such as activated sludge and membrane bioreactors and other hybrid techniques. The purpose of this review is to improve the knowledge on the composition and impact of hospital wastewater on man and the environment, highlighting the different treatment techniques appropriate to this type of disposal before discharge into the environment.

Antibiotic resistance genes in landfill leachates from seven municipal solid waste landfills: Seasonal variations, hosts, and risk assessment

Landfills are reservoir of antibiotics and antibiotic resistance. Antibiotic resistance would transport to the environment through landfill leachate, posing threaten to the environment. However, long term monitoring on antibiotic resistance genes in landfill leachate transportation is limited. Furthermore, antibiotic resistance gene hosts and their risk assessment are lacking. In this study, we investigated the seasonal variation of ARGs sulI, tetO and tetW in seven Chinese municipal solid waste landfill leachates over two years (2017-2018) by quantitative polymerase chain reaction. We also evaluated the associated bacterial hosts and their risk levels based on metagenomics and omics-based framework for assessing the health risk of antimicrobial resistance genes, respectively. Because sulI, tetO and tetW are abundant and the most frequently detected ARGs in global landfill system, they are selected as target ARGs. Results showed that the relative content of target ARGs in 2017 was 100 times higher than that in 2018, suggesting ARGs attenuation. The hosts of sulI were phyla of Lentisphaerae and Proteobacteria, whereas the hosts of tetO and tetW were Bacteroidetes and Firmicutes. Remarkably, the host species include pathogenic bacterium (Salmonella enterica, Labilibaculum filiforme, Bacteroidales bacterium, Anaeromassilibacillus senegalensis, and Pseudochrobactrum sp. B5). ARGs tetO and tetW belong to the Rank II level with characters of enrichment in the human-associated environment and gene mobility, and sulI ranked as Rank VI. In addition, among 1210 known ARGs in the landfill leachate, 78 ARGs belonged to risk Rank I (enrichment in human-associated environment, gene mobility and pathogenicity), demonstrating high health risk of landfill system. These results demonstrate that antibiotic resistance in landfill and landfill leachate have high health risk and the kind of ARGs with high abundance in human-associated environment, gene mobility and pathogenicity should be paid more attention.

Characterization of antibiotic resistance genes and bacteria in a municipal water resource recovery facility

Municipal water resource recovery facilities (WRRFs) are important sources of antibiotic-resistant bacteria and genes (ARB and ARGs). In this study, antibiotic-resistant total heterotrophic bacteria (THB_R ) counts (CFU/ml) cultivated from influent, effluent of activated sludge process, and outflow of disinfection unit of an urban WRRF were investigated for the presence of 16, 32, 64, and 128 μg/ml of nine antibiotics. The isolates of Pseudomonas spp., Acinetobacter spp., and Escherichia coli obtained from effluent of activated sludge process were subjected for molecular identification by detecting the 16S rRNA gene sequences. Additionally, using the polymerase chain reaction method (PCR), the isolates were investigated for the presence of bla_SHV , bla_TEM , bla_CTX-M , bla_VIM , sul1, and qnrS genes. According to the results, the abundance of THB_R counts was not significantly reduced by the biological treatment except for cefixime and sulfamethoxazole; it also increased for some antibiotics after disinfection unit. The average removal efficiency of THB_R resistant to ciprofloxacin, sulfamethoxazole, and ceftazidime were 7.9 ± 1.7%, 41.8 ± 2.1%, and 14.4 ± 6.2%, respectively. Also, all the tested isolates were resistant to at least four antibiotics. For all antibiotics, the resistance ratio (THB_R /THB) significantly increased in the effluent and after chlorination unit. Among 12 resistant isolates, bla_TEM and sul1 genes were the most frequently detected ones involved in 92% and 83% of the isolates, respectively. Both bla_TEM and sul1 genes were found in 100% of E. coli, and 83% and 67% of Pseudomonas spp. isolates, respectively. Further efforts are necessary to limit the transmission of ARB and ARGs from WRRFs into the environment and prevent human health threats. PRACTITIONER POINTS: The ratio of resistance significantly increased after biological treatment. Up to 40% of heterotrophic bacteria in the effluent was antibiotic resistant. bla_TEM and sul1 genes were more prevalent (92%) in all isolates of bacteria. Both bla_TEM and sul1 genes were found in 100% of E. coli isolates. Pseudomonas spp. holds bla_TEM and sul1 genes in 83% and 67% of isolates, respectively.

High Frequency of the EMRSA-15 Clone (ST22-MRSA-IV) in Hospital Wastewater

Hospital wastewaters often carry multidrug-resistant bacteria and priority pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA). Pathogens and antibiotic resistance genes present in wastewaters may reach the natural environment facilitating their spread. Thus, we aimed to isolate MRSA from wastewater of 3 hospitals located in the north of Portugal and to characterize the isolates regarding the antimicrobial resistance and genetic lineages. A total of 96 wastewater samples were collected over six months. The water was filtered, and the filtration membrane was immersed in BHI broth supplemented with 6.5% of NaCl and incubated. The inoculum was streaked in ORSAB agar plates for MRSA isolation. The isolates susceptibility testing was performed against 14 antimicrobial agents. The presence of resistance and virulence genes was accessed by PCR. Molecular typing was performed in all isolates. From the 96 samples, 28 (29.2%) were MRSA-positive. Most isolates had a multidrug-resistant profile and carried the mecA, blaZ, aac(6')-Ie-aph(2″)-Ia, aph(3')-IIIa, ermA, ermB, ermC, tetL, tetM, dfrA dfrG and catpC221 genes. Most of the isolates were ascribed to the immune evasion cluster (IEC) type B. The isolates belonged to ST22-IV, ST8-IV and ST105-II and spa-types t747, t1302, t19963, t6966, t020, t008 and tOur study shows that MRSA can be found over time in hospital wastewater. The wastewater treatment processes can reduce the MRSA load. The great majority of the isolates belonged to ST22 and spa-type t747 which suggests the fitness of these genetic lineages in hospital effluents.