Comprehensive Genomic Survey of Antimicrobial-Resistance Bacteria in the Sewage Tank Replacement with Hospital Relocation

Abstract

Background: Excrement containing antimicrobial-resistant bacteria (ARB) is discharged from the hospital sewage through wastewater treatment plants (WWTP) into rivers, increasing the antimicrobial resistance (AMR) burden on the environment. Purpose: We illustrate the contamination of hospital sewage tanks with ARB harboring antimicrobial resistance genes (ARGs) using comprehensive metagenomic sequencing. During the study period, we moved to a new hospital building constructed for renovation. Therefore, we investigated the difference in bacterial flora in the sewage tanks for each building with different departments, and the change in bacterial flora over time in new sewage tanks. Furthermore, we performed a comparative genome analysis of extended spectrum β-lactamase (ESBL)-producing organisms (EPOs) from hospital sewage and clinical samples. Residual antibiotics in the sewage tank were also measured. Methods: Metagenomic analysis was performed on the hospital sewage samples, followed by whole genome sequencing of EPOs. Results:The bacterial composition of new sewage tanks was comparable with that of old tanks within 1 month after relocation and was instantly affected by excrement. The bacterial composition of sewage tanks in the old and new buildings, containing rooms where seriously ill patients were treated, was similar. Selection on CHROMagar ESBL allowed detection of EPOs harboring bla CTX-M and carbapenemase genes in all sewage tanks. One of the sewage Escherichia coli strain comprising ST393 harboring bla CTX-M-27 corresponded to the clinical isolates based on core genome analysis. Moreover, the levels of levofloxacin and clarithromycin in the hospital sewage were 0.0325 and 0.0135 µg/mL, respectively. Conclusion: Hospital sewage was contaminated with many ARB species, ARGs and residual antibiotics, which can cause a burden on WWTP sewage treatment. The bacterial flora in the sewage tank was rapidly affected, especially by the ward with seriously ill patients. AMR monitoring of hospital sewage may help detect carriers prior to nosocomial ARB-associated outbreaks and control the outbreaks.

Inactivation of Antibiotic-Resistant Bacteria in Wastewater by Ozone-Based Advanced Water Treatment Processes

“…Recent research provides insights into the environmental risk assessment of both AMRB and AMRGs [ 8 , 35 , 112 ]. The risk of infection by AMRB in water and via the ecosystem is increasing, and further development of AMRB in the presence of residual antimicrobials or AMRGs in water is now progressing [ 12 , 113 , 114 , 115 ]. Further, the present study might provide invaluable information to prevent infectious diseases from the aquatic environment, including wastewater.…”

“…The spread of AMRB not only makes it difficult to treat infectious diseases but also increases the risk of epidemics and aggravation. Taking effective measures to prevent the prevalence of AMRB has become urgent [ 10 , 11 , 12 ]. The connection between humans and the environment continues to complicate.…”

Dissecting microbial communities and resistomes for interconnected humans, soil, and livestock

“…Recently there have been studies combining both metagenomic and culture-based analyses [ 25 , 46 , 47 ] but none of these have correlated resistance/susceptibility phenotypes in cultured isolates with metagenomic data. Two recent studies used metagenomic samples to predict AMR and virulence determinants (by comparison of known genes in public databases) of clinical infections; however, typically these samples were mono-or polymicrobial with at most two species [ 48 , 49 ].…”

Comprehensive Genome and Plasmidome Analysis of Antimicrobial Resistant Bacteria in Wastewater Treatment Plant Effluent of Tokyo

“…The importance of the synergy between plasmids and ARGs with flanking insertion sequences (ISs) has also been documented to potentiate the emergence of MDR-hypervirulent clones between WWTP- and human/animal-associated bacteria [ 5 ]. Ekanzala et al reported that hospital wastewater showed significantly higher environmental resistome risk scores than all other assessed matrices [ 9 , 10 ], suggesting that hospital wastewater, effluent, and sewage sludge should be subjected to stringent mitigation measures to minimize such dissemination. Therefore, urban WWTPs are among the main sources of ARB and ARGs released into the environment [ 11 ].…”