Investigation of Antibiotic Resistome in Hospital Wastewater during the COVID-19 Pandemic: Is the Initial Phase of the Pandemic Contributing to Antimicrobial Resistance?

Abstract

Since the COVID-19 pandemic started, there has been much speculation about how COVID-19 and antimicrobial resistance may be interconnected. In this study, untreated wastewater was sampled from Hospital A designated to treat COVID-19 patients during the first wave of the COVID-19 pandemic alongside Hospital B that did not receive any COVID-19 patients. Metagenomics was used to determine the relative abundance and mobile potential of antibiotic resistant genes (ARGs), prior to determining the correlation of ARGs with time/incidence of COVID-19. Our findings showed that ARGs resistant to macrolides, sulfonamides, and tetracyclines were positively correlated with time in Hospital A but not in Hospital B. Likewise, minor extended spectrum beta-lactamases (ESBLs) and carbapenemases of classes B and D were positively correlated with time, suggesting the selection of rare and/or carbapenem-resistant genes in Hospital A. Non-carbapenemase bla VEB also positively correlated with both time and intI1 and was copresent with other ARGs including carbapenem-resistant genes in 6 metagenome-assembled genomes (MAGs). This study highlighted concerns related to the dissemination of antimicrobial resistance (AMR) during the COVID-19 pandemic that may arise from antibiotic use and untreated hospital wastewater.

Changes in Prevalence but Not Hosts of Antibiotic Resistance Genes during the COVID-19 Pandemic versus Prepandemic in Wastewater Influent

“…Note that a significant negative correlation was also observed between the sul 1 gene, conferring resistance to sulfonamides, quantified through qPCR and the COVID-19 cases (See Section ). Similar results were observed in a study of hospital wastewater, where a negative correlation was reported between ARGs belonging to drug classes aminoglycoside, peptides, beta-lactam, fluoroquinolone, and lincosamide and the number of COVID-19 patients . This negative correlation could be attributed to a variety of reasons, including high rates of antibiotic prescription in the initial months of the pandemic followed by the decrease in overall antibiotic usage as the pandemic progressed .…”

“…Similar results were observed in a study of hospital wastewater, where a negative correlation was reported between ARGs belonging to drug classes aminoglycoside, peptides, beta-lactam, fluoroquinolone, and lincosamide and the number of COVID-19 patients. 32 This negative correlation could be attributed to a variety of reasons, including high rates of antibiotic prescription in the initial months of the pandemic followed by the decrease in overall antibiotic usage as the pandemic progressed. 12 Interestingly, the correlation was not significant for either aminoglycoside or sulfonamide when prepandemic samples were included (COVID-19 cases for prepandemic samples were considered zero), underscoring the need for inclusion of samples from a longer time period to understand any pandemic-related changes.…”

“…The study used a combination of qPCR and metagenomic sequencing for analyzing the samples . Using metagenomics, a positive correlation was also observed between the macrolide, tetracycline, sulfonamide, and some beta-lactamase ARG classes and time over three months in hospital wastewater from Saudi Arabia . Likewise, a study from India noted significant increases in antidrug resistance of E. coli in 2020 compared to 2018 using the culture-based Kirby-Bauer disk diffusion method .…”

“…31 Using metagenomics, a positive correlation was also observed between the macrolide, tetracycline, sulfonamide, and some beta-lactamase ARG classes and time over three months in hospital wastewater from Saudi Arabia. 32 Likewise, a study from India noted significant increases in antidrug resistance of E. coli in 2020 compared to 2018 using the culture-based Kirby-Bauer disk diffusion method. 33 To our knowledge, there are no reports to-date of the relative abundance of ARGs and their hosts in wastewater influent nor comparisons of pre-and during-pandemic concentrations of ARGs and their hosts in wastewater influent.…”

Airborne antibiotic resistome and human health risk in railway stations during COVID-19 pandemic

“…The ongoing global pandemic of coronavirus disease 2019 (COVID-19) poses a serious threat to public health ( Huang et al, 2020 , Platto et al, 2020 ). Long before the COVID-19 epidemic, antibiotic resistance was a global public health concern, and it remains so ( Wang et al, 2022 ). Particularly, various antibiotics were used in pandemic disease treatments ( Miranda et al, 2020 ).…”