Antibiotic resistance profile of wastewater treatment plants in Brazil reveals different patterns of resistance and multi resistant bacteria in final effluents.

Wastewater treatment plants (WWTPs) are recognized as important sources of Antibiotic Resistant Bacteria (ARBs) and Antibiotic Resistant Genes (ARGs), and might play a role in the removal and dissemination of antimicrobial resistance (AMR) in the environment. Detailed information about AMR removal by the different treatment technologies commonly applied in urban WWTPs is needed. This study investigated the occurrence, removal and characterization of ARBs in WWTPs employing different technologies: WWTP-A (conventional activated sludge-CAS), WWTP-B (UASB reactor followed by biological trickling filter) and WWTP-C (modified activated sludge followed by UV disinfection-MAS/UV). Samples of raw sewage (RI) and treated effluent (TE) were collected and, through the cultivation-based method using 11 antibiotics, the antibiotic resistance profiles were characterized in a one-year period. MAS was effective in reducing ARB counts (2 to 3 log units), compared to CAS (1 log unit) and UASB/BTF (0.5 log unit). The composition of cultivable ARB differed between RI and TE samples. Escherichia was predominant in RI (56/118); whilst in TE Escherichia (31/118) was followed by Bacillus (22/118), Shigella (14/118) and Enterococcus (14/118). Most of the isolates identified (370/394) harboured at least two ARGs and in over 80 % of the isolates, 4 or more ARG (int1, blaTEM, TetA, sul1 and qnrB) were detected. A reduction in the resistance prevalence was observed in effluents after CAS and MAS processes; whilst a slight increase was observed in treated effluents from UASB/BTF and after UV disinfection stage. The multi-drug resistance (MDR) phenotype was attributed to 84.3 % of the isolates from RI (27/32) and 63.6 % from TE (21/33) samples and 52.3 % of the isolates (34/65) were resistant to carbapenems (imipenem, meropenem, ertapenem). The results indicate that treated effluents are still a source for MDR bacteria and ARGs dissemination to aquatic environments. The importance of biological sewage treatment was reinforced by the significant reductions in ARB counts observed. However, implementation of additional treatments is needed to mitigate MDR bacteria release into the environment.

Quantification of SARS-CoV-2 in wastewater samples from hospitals treating COVID-19 patients during the first wave of the pandemic in Brazil.

The COVID-19 pandemic has caused a global health crisis, and wastewater-based epidemiology (WBE) has emerged as an important tool to assist public health decision-making. Recent studies have shown that the SARS-CoV-2 RNA concentration in wastewater samples is a reliable indicator of the severity of the pandemic for large populations. However, few studies have established a strong correlation between the number of infected people and the viral concentration in wastewater due to variations in viral shedding over time, viral decay, infiltration, and inflow. Herein we present the relationship between the number of COVID-19-positive patients and the viral concentration in wastewater samples from three different hospitals (A, B, and C) in the city of Belo Horizonte, Minas Gerais, Brazil. A positive and strong correlation between wastewater SARS-CoV-2 concentration and the number of confirmed cases was observed for Hospital B for both regions of the N gene (R = 0.89 and 0.77 for N1 and N2, respectively), while samples from Hospitals A and C showed low and moderate correlations, respectively. Even though the effects of viral decay and infiltration were minimized in our study, the variability of viral shedding throughout the infection period and feces dilution due to water usage for different activities in the hospitals could have affected the viral concentrations. These effects were prominent in Hospital A, which had the smallest sewershed population size, and where no correlation between the number of defecations from COVID-19 patients and viral concentration in wastewater was observed. Although we could not determine trends in the number of infected patients through SARS-CoV-2 concentrations in hospitals' wastewater samples, our results suggest that wastewater monitoring can be efficient for the detection of infected individuals at a local level, complementing clinical data.

Gut microbiota from patients with COVID-19 cause alterations in mice that resemble post-COVID symptoms.

Long-term sequelae of coronavirus disease (COVID)-19 are frequent and of major concern. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection affects the host gut microbiota, which is linked to disease severity in patients with COVID-19. Here, we report that the gut microbiota of post-COVID subjects had a remarkable predominance of Enterobacteriaceae strains with an antibiotic-resistant phenotype compared to healthy controls. Additionally, short-chain fatty acid (SCFA) levels were reduced in feces. Fecal transplantation from post-COVID subjects to germ-free mice led to lung inflammation and worse outcomes during pulmonary infection by multidrug-resistant Klebsiella pneumoniae. transplanted mice also exhibited poor cognitive performance. Overall, we show prolonged impacts of SARS-CoV-2 infection on the gut microbiota that persist after subjects have cleared the virus. Together, these data demonstrate that the gut microbiota can directly contribute to post-COVID sequelae, suggesting that it may be a potential therapeutic target.

Effects of activated sludge and UV disinfection processes on the bacterial community and antibiotic resistance profile in a municipal wastewater treatment plant.

Wastewater tertiary treatment has been pointed out as an effective alternative for reducing the concentration of antibiotic resistant bacteria and genes (ARB and ARGs) in wastewaters. The present work aimed to build on the current knowledge about the effects of activated sludge and UV irradiation on antibiotic resistance determinants in biologically treated wastewaters. For that, the microbial community and ARGs' composition of samples collected after preliminary (APT), secondary (AST), and tertiary (ATT) treatments in a full-scale wastewater treatment plant using a modified activated sludge (MAS) system followed by an UV stage (16 mJ/cm2) were investigated through culture-dependent and independent approaches (including metagenomics). A total of 24 phyla and 460 genera were identified, with predominance of Gammaproteobacteria in all samples. Pathogenic genera corresponded to 8.6% of all sequences on average, mainly Acinetobacter and Streptococcus. Significant differences (p < 0.05) in the proportion of pathogens were observed between APT and the other samples, suggesting that the secondary treatment reduced its abundance. The MAS achieved 64.0-99.7% average removal efficiency for total (THB) and resistant heterotrophic bacteria, although the proportions of ARB/THB have increased for sulfamethoxazole, cephalexin, ciprofloxacin, and tetracycline. A total of 107 copies/mL of intI1 gene remained in the final effluent, suggesting that the treatment did not significantly remove this gene and possibly other ARGs. In accordance, metagenomic results suggested that number of reads recruited to plasmid-associated ARGs became more abundant in the pool throughout the treatment, suggesting that it affected more the bacteria without these ARGs than those with it. In conclusion, disinfected effluents are still a potential source for ARB and ARGs, which highlights the importance to investigate ways to mitigate their release into the environment.

Reduction and liquid-solid partitioning of SARS-CoV-2 and adenovirus throughout the different stages of a pilot-scale wastewater treatment plant.

Investigating waterborne viruses is of great importance to minimizing risks to public health. Viruses tend to adsorb to sludge particles from wastewater processes by electrostatic and hydrophobic interactions between virus, aquatic matrix, and particle surface. Sludge is often re-used in agriculture; therefore, its evaluation is also of great interest to public health. In the present study, a pilot scale system treating real domestic wastewater from a large city in Brazil was used to evaluate the removal, the overall reduction, and liquid-solid partitioning of human adenovirus (HAdV), the novel coronavirus (SARS-CoV-2) and fecal indicators (F-specific coliphages and E. coli). The system consists of a high-rate algal pond (HRAP) post-treating the effluent of an upflow anaerobic sludge blanket (UASB) reactor. Samples were collected from the influent and effluent of each unit, as well as from the sludge of the UASB and from the microalgae biomass in the HRAP. Pathogens and indicators were quantified by quantitative polymerase chain reaction (qPCR) (for HAdV), qPCR with reverse transcription (RTqPCR) (for SARS-CoV-2), the double agar plaque assay (for coliphages), and the most probable number (MPN) method (for E. coli). The removal and overall reduction of HAdV and SARS-CoV-2 was greater than 1-log10. Almost 60% of remaining SARS-CoV-2 RNA and more than 70% of remaining HAdV DNA left the system in the sludge, demonstrating that both viruses may have affinity for solids. Coliphages showed a much lower affinity to solids, with only 3.7% leaving the system in the sludge. The system performed well in terms of the removal of organic matter and ammoniacal nitrogen, however tertiary treatment would be necessary to provide further pathogen reduction, if the effluent is to be reused in agriculture. To our knowledge, this is the first study that evaluated the reduction and partitioning of SARS-CoV-2 and HAdV through the complete cycle of a wastewater treatment system consisting of a UASB reactor followed by HRAPs.

Long-term monitoring of SARS-CoV-2 RNA in sewage samples from specific public places and STPs to track COVID-19 spread and identify potential hotspots.

Coronavirus pandemic started in March 2020 and since then has caused millions of deaths worldwide. Wastewater-based epidemiology (WBE) can be used as an epidemiological surveillance tool to track SARS-CoV-2 dissemination and provide warning of COVID-19 outbreaks. Considering that there are public places that could be potential hotspots of infected people that may reflect the local epidemiological situation, the presence of SARS-CoV-2 RNA was analyzed by RT-qPCR for approximately 16 months in sewage samples from five public places located in the metropolitan area of Belo Horizonte, MG, Brazil: the sewage treatment plant of Confins International Airport (AIR), the main interstate bus terminal (BUS), an upscale shopping centre (SHC1), a popular shopping centre (SHC2) and a university institute (UNI). The results were compared to those of the influent sewage of the two main sewage treatment plants of Belo Horizonte (STP1 and STP2). Viral monitoring in the STPs proved to be an useful regional surveillance tool, reflecting the trends of COVID-19 cases. However, the viral concentrations in the samples from the selected public places were generally much lower than those of the municipal STPs, which may be due to the behaviour of the non-infected or asymptomatic people, who are likely to visit these places relatively more than the symptomatic infected ones. Among these places, the AIR samples presented the highest viral concentrations and concentration peaks were observed previously to local outbreaks. Therefore, airport sewage monitoring can provide an indication of the regional epidemiological situation. For the other places, particularly the UNI, the results suggested a greater potential to detect the infection and trace cases especially among employees and regular attendees. Taken together, the results indicate that for a regular and permanent sentinel sewage surveillance the sewage from STPs, AIR and UNI could be monitored.

Persulfate mediated solar photo-Fenton aiming at wastewater treatment plant effluent improvement at neutral PH: emerging contaminant removal, disinfection, and elimination of antibiotic-resistant bacteria.

This work investigated an innovative alternative to improve municipal wastewater treatment plant effluent (MWWTP effluent) quality aiming at the removal of contaminants of emerging concern (caffeine, carbendazim, and losartan potassium), and antibiotic-resistant bacteria (ARB), as well as disinfection (E. coli). Persulfate was used as an alternative oxidant in the solar photo-Fenton process (solar/Fe/S2O82-) due to its greater stability in the presence of matrix components. The efficiency of solar/Fe/S2O82- at neutral pH using intermittent iron additions is unprecedented in the literature. At first, solar/Fe/S2O82- was performed in a solar simulator (30 W m-2) leading to more than 60% removal of CECs, and the intermittent iron addition strategy was proved effective. Then, solar/Fe/S2O82- and solar/Fe/H2O2 were compared in semi-pilot scale in a raceway pond reactor (RPR) and a cost analysis was performed. Solar/Fe/S2O82- showed higher efficiencies of removal of target CECs (55%), E. coli (3 log units), and ARB (3 to 4 log units) within 1.9 kJ L-1 of accumulated irradiation compared to solar/Fe/H2O2 (CECs, 49%; E. coli, 2 log units; ARB, 1 to 3 log units in 2.5 kJ L-1). None of the treatments generated acute toxicity upon Allivibrio fischeri. Lower total cost was obtained using S2O82- (0.6 € m-3) compared to H2O2 (1.2 € m-3). Therefore, the iron intermittent addition aligned to the use of persulfate is suitable for MWWTP effluent quality improvement at neutral pH.

Assessing spatial distribution of COVID-19 prevalence in Brazil using decentralised sewage monitoring.

Brazil has become one of the epicentres of the COVID-19 pandemic, with cases heavily concentrated in large cities. Testing data is extremely limited and unreliable, which restricts health authorities' ability to deal with the pandemic. Given the stark demographic, social and economic heterogeneities within Brazilian cities, it is important to identify hotspots so that the limited resources available can have the greatest impact. This study shows that decentralised monitoring of SARS-CoV-2 RNA in sewage can be used to assess the distribution of COVID-19 prevalence in the city. The methodology developed in this study allowed the identification of hotspots by comprehensively monitoring sewers distributed through Belo Horizonte, Brazil's third largest city. Our results show that the most vulnerable neighbourhoods in the city were the hardest hit by the pandemic, indicating that, for many Brazilians, the situation is much worse than reported by official figures.

Effect of alkaline treatment on pathogens, bacterial community and antibiotic resistance genes in different sewage sludges for potential agriculture use.

Alkaline treatment is widely used to reduce pathogens in sewage sludge in developing countries and guarantee that it is safe for use in agriculture. The aim of this study was to investigate the effect of alkaline treatment applied to waste-activated (WAS) and Upflow Anaerobic Sludge Blanket (UASB)-sludge on the bacterial community, pathogens (viable helminths eggs and Salmonella spp), and antibiotic resistance genes (ARG). The bacterial community structure was examined through denaturing gel gradient electrophoresis (DGGE), targeting 16S rRNA genes. Polymerase chain reaction (PCR) was applied to evaluate the presence of several ARGs. The conducted alkaline experiment consisted of adding hydrated lime (Ca(OH)2) to sewage sludges. Samples were taken before and after 2, 24, 48, and 72 hours of treatment. Alkaline treatment changed considerably the bacterial community structure and after 24 hours, shifts in bacterial profiles were more pronounced in the UASB sludge sample than in WAS. Some bacteria remained under extreme pH conditions (pH > 12), such as Azospira oryzae and Dechloromonas denitrificans in the WAS samples, and Geothrix and Geobacter in the UASB sludge samples. The values of pathogens and indicators in the sludge after 24 hours of alkaline treatment meet sanitary law regulations and thus the sludges could have the potential to agricultural distribution. It is important to highlight that ARG, which are not currently present in sanitary regulations, were detected in the sludge samples after the alkaline treatment, which could be a concern for human health.

Monitoramento do esgoto como ferramenta de vigilância epidemiológica para controle da COVID-19: estudo de caso na cidade de Belo Horizonte / Sewage monitoring as a surveillance epidemiological tool for COVID-19 control: a case study in the city of Belo Horizonte

RESUMO A recente detecção de material genético (RNA) do novo coronavírus em amostras de fezes e no esgoto aponta para a possibilidade de se identificar a circulação do vírus e até mesmo estimar o número de pessoas infectadas em determinada região pelo monitoramento sistemático do esgoto, configurando-se em importante ferramenta epidemiológica de testagem massiva indireta, incluindo portadores sintomáticos e assintomáticos. Nesse sentido, concebeu-se um projeto para a detecção e a quantificação do novo coronavírus em amostras de esgoto coletadas em 15 sub-bacias de esgotamento sanitário dos ribeirões Arrudas e Onça, visando entender a dinâmica de circulação e a prevalência do vírus nas regiões investigadas. Tais sub-bacias esgotam os efluentes gerados por uma população da ordem de 1,5 milhão de pessoas no município de Belo Horizonte e parte de Contagem. O plano de amostragem contemplou 17 pontos (15 sub-bacias + afluente às 2 estações de tratamento de esgoto) de monitoramento semanal, com coletas compostas durante todo o período da manhã. A detecção e a quantificação do RNA viral efetuaram-se em laboratório por meio de ensaios de RT-qPCR. Os resultados obtidos em quatro semanas de monitoramento (semanas epidemiológicas 21 a 24) mostraram um incremento da ocorrência do vírus, atingindo 100% das regiões investigadas na semana epidemiológica 24. A estimativa da população infectada pelo novo coronavírus pelo monitoramento do esgoto em Belo Horizonte apresentou tendência de crescimento exponencial, sendo até 20 vezes maior do que o número de casos confirmados acumulados. Quanto à circulação do vírus, as concentrações do RNA viral têm se mostrado bastante variáveis nas regiões monitoradas, com maiores porcentagens de população infectada estimada ao norte e nordeste da capital mineira.

ABSTRACT The recent detection of SARS-CoV-2 RNA in stool and sewage samples highlights the possibility of mapping the circulation of the virus and even estimating the number of infected people through the systematic monitoring of sewage in a specific region. Therefore, this is an important epidemiological tool for large-scale indirect testing, including symptomatic and asymptomatic carriers. This project was conceived for the detection and quantification of the SARS-CoV-2 in sewage samples collected in 15 watersheds of the Arrudas and Onça streams, aiming to understand the dynamics of spread and the prevalence of the virus in these regions/watersheds. These sub-basins exhaust the effluents generated by a population of approximately 1.5 million people in the municipality of Belo Horizonte and part of Contagem. Weekly composite samples were collected during the morning periods in seventeen monitoring points (15 water sheds + influent to 2 sewage treatment plants). RNA detection and quantification were performed in the laboratory using RT-qPCR. The results obtained in four weeks of monitoring (epidemiological weeks 21 to 24) showed an increase in the occurrence of the virus, reaching 100% of the monitored regions investigated in epidemiological week 24. The infected population, estimated by sewage monitoring in Belo Horizonte, showed exponential growth, being up to 20 times higher than those of accumulated confirmed cases. As for the dynamics of virus spread, RNA concentrations have shown to be quite variable in the monitored regions with higher percentages of the estimated infected population in the northern and north-eastern portions of Belo Horizonte.

Detecção e quantificação de bactérias resistentes aos antibióticos ampicilina e cloranfenicol em estações de tratamento de esgoto doméstico / Detection and quantification of bacteria resistant to ampicillin and chloranphenicol in domestic sewage treatment plants

RESUMO Estações de tratamento de esgotos (ETEs) estão entre as principais fontes de disseminação de bactérias resistentes a antibióticos (BRAs) e genes de resistência (GRAs) no ambiente. Este trabalho quantificou a ocorrência de bactérias resistentes aos antibióticos ampicilina e cloranfenicol no esgoto bruto (EB), no efluente tratado (ET) e no lodo de duas ETEs em escala plena por um período de nove meses. As unidades investigadas utilizavam os seguintes sistemas de tratamento: ETE-A, sistema de lodos ativados convencional; e a ETE-B, reatores anaeróbios (UASB) seguidos de filtros biológicos percoladores (FBP). Os resultados evidenciaram que a ETE-A foi mais eficiente na redução das concentrações de bactérias resistentes à ampicilina e ao cloranfenicol (cerca de 1,1 e 0,7 log10UFC.mL−1 de remoção, respectivamente), quando comparada com a ETE-B (0,5log10 UFC.mL−1 de remoção para as bactérias resistentes ao cloranfenicol e nenhuma remoção para as resistentes à ampicilina). As amostras de lodo, de ambas ETEs, apresentaram elevadas concentrações de bactérias heterotróficas totais — BHTs (4,8-7,6 log10UFC.mL−1) e de BRAs (3,0-6,3 log10UFC.mL−1). A maioria das cepas resistentes à ampicilina e ao cloranfenicol isoladas foi identificada como sendo da família Enterobacteriaceae. Algumas das espécies identificadas são bactérias potencialmente patogênicas, tais como: Klebsiella pneumoniae, Aeromonas hydrophila, Escherichia coli, Enterococcus faecium, Salmonella spp. Os resultados chamam a atenção para a disseminação de BRAs, potencialmente patogênicas, no meio ambiente a partir do efluente final (proveniente do tratamento secundário) das ETEs, independentemente do tipo de sistema adotado. Fica evidente que para reduzir significativamente a concentração das BRAs no ET, este deveria passar por tratamento adicional e desinfecção.

ABSTRACT Sewage treatment plants (STP) are among the main sources of dissemination of antibiotic-resistant bacteria (ARB) and antibiotic-resistance genes (ARG) into the environment. This work quantified the occurrence of cultivable ampicilin-resistant and chloramphenicol-resistant bacteria in raw sewage, treated effluent and sludge samples from two full-scale STP over nine months. The STP investigated used the following treatment systems: STP-A used conventional activated sludge system; and STP-B, anaerobic reactors (UASB) followed by percolating biological filters (PBF). Results showed that was more efficient in reducing the concentrations of ampicilin- and chloramphenicol-resistant bacteria (around 1.1 and 0.7 log10UFC.mL−1, respectively) when compared to STP-B (0.5 log10 UFC.mL−1 removal of cloramphenicol-resistant bacteria and no-removal of ampicilin-resistant bacteria). Sludge samples, from both STP, showed high concentrations of total heterotrophic bacteria (THB; 4.8-7.6 log10UFC.mL−1) and ARB (3.0-6.3 log10UFC.mL−1). Most of the isolated ampicilin- and chloramphenicol-resistant strains were identified as members of the Enterobacteriaceae family. Some of the identified species are potential pathogenic bacteria, such as Klebsiella pneumoniae, Aeromonas hydrophila, Escherichia coli, Enterococcus faecium, Salmonella spp. These results call attention to the spread of ARB, potentially pathogenic, in the environment from the final effluent (from secondary effluent) on the STP, regardless of the type of system adopted. It is evident that in order to significantly reduce the concentration of ARB in the treated effluent, it should undergo additional treatment and disinfection.

Identificação de perigos e pontos críticos de controle e avaliação das práticas de fabricação de uma indústria mineira de pão de queijo / Identification of dangers and control critics points and evaluation of the practices of making of a cheese bread miner industry

A aceitação do pão de queijo, além de seu consumo interno no Estado de Minas Gerais, ganhou o âmbito nacional, levando a indústria mineira, de maior e menor porte, a se interessar e buscar a qualidade do produto. A implantação de programas que visam a obtenção desta qualidade constitui instrumento eficiente e, quase sempre, pouco oneroso, destacando-se, em função de sua exeqüibilidade, o sistema APPCC. Com vista a estes objetivos, foi estudada uma Indústria Mineira de pão de queijo, então designada IMpq, que, produzia e colocava diariamente 6t do produto congelado no mercado. Com auxílio de um questionário de inspeção, especialmente modificado para este fim, vistorias periódicas foram realizadas. Processamento e seu fluxo; condições de recepção, armazenagem e manipulação da matéria-prima; uso de equipamentos e utensílios; situação de limpeza, sanificação e edificação da indústria e comportamento de manipuladores envolvidos na linha de produção foram enfocados. Estes itens, desdobrados em 53 sub itens, foram pesquisados, de maneira equânime, e a eles atribuídos valores de 0 a 60 pontos, para posterior conceituação de A a D. Os dados gerados, através de criteriosa observação e da análise de informações emitidas por 13 manipuladores, evidenciaram a matéria prima, equipamentos e utensílios e área de produção como aqueles responsáveis pelo maior número de irregularidades. No Cômputo geral, foi conferida à indústria em questão pontuação 33 e conceito C, ficando constatada a necessidade da implantação de Boas Práticas de Fabricação, BPF.

Monitoramento da qualidade microbiológica em uma indústria mineira de pão de queijo. Superfícies de equipamentos e utensílios / Monitoring from the microbiological quality in a cheese bread miner industry. Surfaces of equipment and utensils

Análise microbiológica de superfícies de equipamentos e utensílios foi procedida em Indústria Mineira de pão de queijo, então designada IMpq, com intuito de conferir, em uma primeira etapa, a eficiência dos procedimentos de higienização por ela praticados e, em uma segunda etapa, caso fosse necessário, validar alterações e/ou correções sugeridas à melhoria destes mesmos procedimentos. Desta maneira, esfregaços de superfícies de cinco equipamento e utensílios, foram realizados utilizando-se a técnica de ôswabsö. Os resultados evidenciados na primeira etapa revelaram para maioria dos equipamentos e utensílios contagens de >2,0 x 105 UFC/cm²; >1,1 x 10³NMP/cm²; >1,1 x 10³NMP/cm²; >2,0 x 105 UFC/cm²; >2,0 x 105 UFC/cm², respectivamente, para bactérias aeróbias mesófilas, coliformes totais, coliformes fecais e estafilococos produtores e não produtores de coagulase. Em função da constatação destes resultados, alterações do procedimento de higienização, que consistiu inicialmente da remoção de detritos orgânicos, pela lavagem de superfícies com jatos de água quente, seguida da aplicação de detergente / sanitizante, posterior enxágüe com jatos de água quente e borrifamento final de solução de hipoclirito de sódio a 1 por cento, foram introduzidas e monitoradas. Redução de dois ciclos log na população de bactérias aeróbias mesófilas (2,0 x 10³UFC/cm²); ausência de coliformes totais e fecais (<2,0NMP / cm²) e igualmente ausência de estafilococos produtores e não produtores de coagulase (<100UFC / cm²) foram evidenciados, revelando-se a possibilidade de se obter superfícies microbiologicamente compatibilizadas com as Boa Práticas de Fabricação(BPF).