Prevalence of Antibiotic-Resistant Pathogenic Bacteria and Level of Antibiotic Residues in Hospital Effluents in Selangor, Malaysia: Protocol for a Cross-sectional Study (Preprint)

Abstract

UNSTRUCTURED Abstract Background Antimicrobial resistance (AMR) has emerged as one of public health challenges globally due to overused and misused of antibiotics by human and animals. Objectives To determine the prevalence of antibiotics resistant pathogenic bacteria and level of antibiotic residues in the hospital’s effluent in Selangor, Malaysia. Methods A cross-sectional study will be conducted in Selangor, Malaysia. The methods are divided into three sections; sample collection, microbiological analysis and, chemical analysis. Microbiological analysis such as isolation of bacteria from the effluent by culture on selective media plates will be performed. An antibiotic sensitivity testing will be performed on the grown bacteria. The identified bacteria will be confirmed using 16sRNA PCR and Multiplex PCR will be performed to detect the resistant genes. Finally, the level of antibiotic residues will be measured using Ultra High Performance Liquid Chromatography (UHPLC) Results The expected outcome will be the prevalence of antibiotic resistant 'ESKAPE' bacteria from the hospital’s effluent and the occurrence of the antibiotic resistant genes (ARGs) from the isolated ESKAPE bacteria and the level of antibiotic residues that may be detected from the effluent. As in July 2022, 80% of Enterococcus faecium were resistance against vancomycin and 10% of were resistance against ciprofloxacin from one hospital. Further analysis will be conducted to determine if the isolates are possessing any antibiotic resistant genes and effluent samples are being analyzed to detect antibiotic residues in the effluent samples. Sampling activities will be resumed actively after suspended due to COVID-19 pandemic.