Cost-effectiveness of resistance-guided therapy for Mycoplasma genitalium in Australia.

The recommended first-line treatment for Mycoplasma genitalium infections is azithromycin. However, the prevalence of macrolide resistance for M. genitalium has increased to more than 50% worldwide. In 2013, Australia introduced a resistance-guided therapy (RGT) strategy to manage M. genitalium infections. This study assesses the cost-effectiveness of the RGT approach compared to no RGT (i.e., without macrolide resistance profile test) in women, men who have sex with men (MSM), and men who have sex with women (MSW) in Australia. We constructed dynamic transmission models of M. genitalium infections in women, MSM, and MSW in Australia, each with a population of 100,000. These models compared the costs and quality-adjusted life-years (QALYs) gained between RGT and no RGT scenarios from a healthcare perspective over ten years. All costs are reported in 2022 Australian dollars (Australian $). In our model, RGT is cost saving in women and MSM, with the incremental net monetary benefit of $1.3 million and $17.9 million, respectively. In MSW, the RGT approach is not cost-effective, with an incremental cost-effectiveness ratio of -$106.96 per QALY gained. RGT is cost saving compared to no RGT for M. genitalium infections in women and MSM, supporting its adoption as the national management strategy for these two population groups.

Seasonal patterns, fate and ecological risk assessment of pharmaceutical compounds in a wastewater treatment plant with Bacillus bio-reactor treatment.

Pharmaceutical compounds (PhCs) pose a growing concern with potential environmental impacts, commonly introduced into the environment via wastewater treatment plants (WWTPs). The occurrence, removal, and season variations of 60 different classes of PhCs were investigated in the baffled bioreactor (BBR) wastewater treatment process during summer and winter. The concentrations of 60 PhCs were 3400 ± 1600 ng/L in the influent, 2700 ± 930 ng/L in the effluent, and 2400 ± 120 ng/g dw in sludge. Valsartan (Val, 1800 ng/L) was the main contaminant found in the influent, declining to 520 ng/L in the effluent. The grit chamber and BBR tank were substantially conducive to the removal of VAL. Nonetheless, the BBR process showcased variable removal efficiencies across different PhC classes. Sulfadimidine had the highest removal efficiency of 87 ± 17% in the final effluent (water plus solid phase). Contrasting seasonal patterns were observed among PhC classes within BBR process units. The concentrations of many PhCs were higher in summer than in winter, while some macrolide antibiotics exhibited opposing seasonal fluctuations. A thorough mass balance analysis revealed quinolone and sulfonamide antibiotics were primarily eliminated through degradation and transformation in the BBR process. Conversely, 40.2 g/d of macrolide antibiotics was released to the natural aquatic environment via effluent discharge. Gastric acid and anticoagulants, as well as cardiovascular PhCs, primarily experienced removal through sludge adsorption. This study provides valuable insights into the intricate dynamics of PhCs in wastewater treatment, emphasizing the need for tailored strategies to effectively mitigate their release and potential environmental risks.

An Updated Economic Assessment of Moxidectin Treatment Strategies for Onchocerciasis Elimination.

BACKGROUND: Concerns that annual mass administration of ivermectin, the predominant strategy for onchocerciasis control and elimination, may not lead to elimination of parasite transmission (EoT) in all endemic areas have increased interest in alternative treatment strategies. One such strategy is moxidectin. We performed an updated economic assessment of moxidectin- relative to ivermectin-based strategies. METHODS: We investigated annual and biannual community-directed treatment with ivermectin (aCDTI, bCDTI) and moxidectin (aCDTM, bCDTM) with minimal or enhanced coverage (65% or 80% of total population taking the drug, respectively) in intervention-naive areas with 30%, 50%, or 70% microfilarial baseline prevalence (representative of hypo-, meso-, and hyperendemic areas). We compared programmatic delivery costs for the number of treatments achieving 90% probability of EoT (EoT90), calculated with the individual-based stochastic transmission model EPIONCHO-IBM. We used the costs for 40 years of program delivery when EoT90 was not reached earlier. The delivery costs do not include drug costs. RESULTS: aCDTM and bCDTM achieved EoT90 with lower programmatic delivery costs than aCDTI with 1 exception: aCDTM with minimal coverage did not achieve EoT90 in hyperendemic areas within 40 years. With minimal coverage, bCDTI delivery costs as much or more than aCDTM and bCDTM. With enhanced coverage, programmatic delivery costs for aCDTM and bCDTM were lower than for aCDTI and bCDTI. CONCLUSIONS: Moxidectin-based strategies could accelerate progress toward EoT and reduce programmatic delivery costs compared with ivermectin-based strategies. The costs of moxidectin to national programs are needed to quantify whether delivery cost reductions will translate into overall program cost reduction.

Assessment of the efficacy of Piper methysticum (Micrembryeae: Piperaceae) as a bioinsecticide, and/or spinosad combined with attractive plant volatiles for a novel lure and kill strategy against Bactrocera tryoni (Diptera: Tephritidae) in laboratory.

The Queensland fruit fly, Bactrocera tryoni (Froggatt) (Diptera: Tephritidae), is a crop pest of global economic importance because of its wide range of hosts and its invasiveness capacities. To develop a novel integrated and sustainable crop protection, we have investigated the insecticidal properties of different varieties of kava (Piper methysticum [Frost]) extracted by two methods and the attractive effects of six plant volatiles identified from B. tryoni host plants to female, mated or not. We did not identify any significant insecticidal effect of the traditional Pacific kava plant at the tested concentrations. Among mated females, ethyl acetate compared to the no odor control elicited the highest attraction (87%, of which 60% for this odor), while ethyl butyrate was preferred compared with ethyl acetate in dual choice assays. Flies' preferences for specific odors depended on their mating status and the odor landscape they were confronted with. Combination with the commercial ingestion insecticide (Success 4: spinosad, 480 g/l, Dow AgroSciences, Valbonne, France) with the plant volatiles were tested to detect an increase in mortality related to the addition of an attractant. The 2-heptanone slightly showed a tend to increase the attractiveness of mated females within 4-6 h to the food bait, but the results were not statistically significant after 8 h. Further tests should be performed with other concentrations or mixtures of the identified host plant volatiles to develop a strong lure and kill strategy.

Long-term toxicity assessment of antibiotics against Vibrio fischeri: Test method optimization and mixture toxicity prediction.

The current luminescent bacteria test for acute toxicity with short contact time was invalid for antibiotics, and the non-uniformed contact times reported in the literature for long-term toxicity assessment led to incomparable results. Herein, a representative long-term toxicity assessment method was established which unified the contact time of antibiotics and Vibrio fischeri within the bioluminescence increasing period (i.e. 10-100% maximum luminescence) of control samples. The effects of excitation and detoxification of antibiotics such as ß-lactams were discovered. Half maximal inhibitory concentration (IC50) of toxic antibiotics (0.00069-0.061 mmol/L) obtained by this method was 2-3 orders of magnitude lower than acute test, quantifying the underestimated toxicity. As antibiotics exist in natural water as mixtures, an equivalent concentration addition (ECA) model was built to predict mixture toxicity based on physical mechanism rather than mathematical method, which showed great fitting results (R2 = 0.94). Furthermore, interaction among antibiotics was investigated. Antibiotics acting during bacterial breeding period had strong synergistic inhibition (IC50 relative deviation from 0.1 to 0.6) such as macrolides and quinolones. Some antibiotics produced increasing synergistic inhibition during concentration accumulation, such as macrolides. The discharge of antibiotics with severe long-term toxicity and strong synergistic inhibition effect should be seriously restricted.

Assessment of the health risks associated with the consumption of bivalve mollusks potentially contaminated with phycotoxins from the coastal ecosystem of the Ebrié lagoon, Côte d'Ivoire.

This work focused on assessing of the risk associated with the consumption of bivalve mollusks, potentially contaminated with phycotoxins. The studied phycotoxins are saxitoxin (STX), okadaic acid (OA), dinophysistoxins (DTXs), yessotoxins (YTXs), pectenotoxins (PTX), azaspiracids (AZAs), and domoic acid (DA). These toxins were investigated in three species of bivalve mollusks (Anadara senilis, Crassostrea gasar, and Perna perna), originating from the Ebrié lagoon. Chemical analyses were carried out by LC-MS/MS, HPLC-FLD, and HPLC-UV. The level of OA and DTXs, STX, and DA was 10.92 µg OA eq./kg, 9.6 µg STX eq./kg, and 0.17 mg DA eq./kg, respectively. The level of PTXs and AZAs was 3.3 µg PTX-2 eq./kg and 13.86 µg AZA-1 eq./kg; that of YTXs was 0.01 mg YTX eq./kg. The daily exposure dose (DED) was 0.019 µg OA eq./kg bw for OA and DTXs; 0.285 µg DA eq./kg bw for DA; 0.006 µg PTX-2 eq./kg bw for PTXs; 0.016 µg STX eq./kg bw for STX; 0.01 µg YTX eq./kg bw for YTXs; and 0.024 µg AZA-1 eq./kg bw for AZAs for the oyster Crassostrea gasar. These estimated values are lower than the acute reference dose (ARfD) of each phycotoxin recommended by the European Food Safety Agency (EFSA). The risk of harmful effects is acceptable. The absence of risk is valid only for the study period (11 months) and concerns coastal populations living near the sampling points.

Assessment of the combined inputs of antimicrobials from top soil improvers and irrigation waters on green leafy vegetable fields.

Sustainable food systems involve the recycling of biowaste and water. This study characterizes thirty-one top soil improvers of anthropogenic, animal, and green waste origin, along with eleven irrigation waters from rivers, channels, and civil wastewater treatment plants (cWWTPs) for the presence of antimicrobials. Liquid chromatography coupled with hybrid High-Resolution Mass Spectrometry (LC-HRMS/MS) was employed to identify forty-eight drugs belonging to the classes of sulfonamides (11), tetracyclines (7), fluoroquinolones (10), macrolides (12), amphenicols (3), pleuromutilins (2), diaminopyrimidines (1), rifamycins (1) and licosamides (1). Sludge from cWWTPs, animal manure, slurry, and poultry litter exhibited the highest loads for sulfonamides, tetracyclines, fluoroquinolones and macrolides (80, 470, 885, and 4,487 ng g-1 wet weight, respectively) with nor- and ciprofloxacin serving as markers for anthropogenic sources. In compost and digestate, antimicrobials were found to be almost always below the limits of quantification. Reused water from cWWTPs for irrigation in open-field lettuce production were contaminated in the range of 12-221 ng L-1 with sulfonamides, tetracyclines, and fluoroquinolones, compared to very few detected in channels and surface waters. The Antimicrobials Hazard Index (HI), based on the Predicted No Effect Concentration for Antimicrobial Resistance (PNECAMR), was significantly >100 in contaminated topsoil improvers from urban and animal sources. Accounting for worst-case inputs from topsoil improvers and irrigation water, as well as dilution factors in amended soil, fluoroquinolones only exhibited an HI around 1 in open fields for lettuce production. The origin of topsoil improvers plays a pivotal role in ensuring safe and sustainable leafy vegetable production, thereby mitigating the risk of Antimicrobial Resistance (AMR) onset in food-borne diseases and the transfer of AMR elements to the human gut flora.

Oral fluoroquinolones and risk of aortic aneurysm or dissection: A nationwide population-based propensity score-matched cohort study.

STUDY OBJECTIVE: To investigate risk of aortic aneurysm or dissection in patients using oral fluoroquinolones compared to those using macrolides in real-world clinical practice among a large US general population. DESIGN: Retrospective cohort study design. DATA SOURCE: MarketScan commercial and Medicare supplemental databases. PATIENTS: Adults patients with at least one prescription fill for fluoroquinolone or macrolide antibiotics. INTERVENTION: Fluoroquinolone or macrolide antibiotics. MEASUREMENTS AND MAIN RESULTS: The primary outcome was estimated incidence of aortic aneurysm or dissection associated with the use of fluoroquinolones compared with macrolides during a 60-day follow-up period in a 1:1 propensity score-matched cohort. We identified 3,174,620 patients (1,587,310 in each group) after 1:1 propensity score matching. Crude incidence of aortic aneurysm or dissection was 1.9 cases per 1000 person-years among fluoroquinolone users and 1.2 cases per 1000 person-years among macrolide users. In multivariable Cox regression, compared with macrolides, the use of fluoroquinolones was associated with an increased risk of aortic aneurysm or dissection (aHR: 1.34; 95% CI: 1.17-1.54). The association was primarily driven by a high incidence of aortic aneurysm cases (95.8%). Results of sensitivity (e.g., fluoroquinolone exposure ranging from 7 to 14 days (aHR: 1.47; 95% CI: 1.26-1.71)) and subgroup analyses (e.g., ciprofloxacin (aHR: 1.26; 95% CI: 1.07-1.49) and levofloxacin (aHR: 1.44; 95% CI: 1.19-1.52)) remained consistent with main findings. CONCLUSIONS: Fluoroquinolone use was associated with a 34% increased risk of aortic aneurysm or dissection compared with macrolide use among a general US population.

Update in Epidemiology and Management of Mycoplasma genitalium Infections.

Mycoplasma genitalium is a frequent cause of urogenital syndromes in men and women and is associated with adverse sequelae in women. M genitalium also infects the rectum, and may cause proctitis, but rarely infects the pharynx. Diagnosis requires nucleic acid amplification testing. Antibiotic resistance is widespread: more than half of infections are resistant to macrolides and fluoroquinolone resistance is increasing. Resistance-guided therapy is recommended for symptomatic patients, involving initial treatment with doxycycline to reduce organism load followed by azithromycin for macrolide-sensitive infections or moxifloxacin for macrolide-resistant infections. Neither screening nor tests of cure are recommended in asymptomatic persons.

Antibiotic residues of drinking-water and its human exposure risk assessment in rural Eastern China.

Trace levels of antibiotics were frequently found in drinking-water, leading a growing concern that drinking-water is an important exposure source to antibiotics in humans. In this study, we investigated antibiotics in tap water and well water in two rural residential areas in Eastern China to assess the related human health exposure risks in drinking-water. Twenty-seven antibiotics were analyzed using ultra performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS). The average daily dose (ADD) and the health risk quotient (HRQ) for exposure to antibiotics in humans were evaluated using 10000 times of Monte Carlo simulations. Ten antibiotics were detected in drinking-water samples, with the maximum concentrations of antibiotic mixture of 8.29 ng/L in tap water and 2.95 ng/L in well water, respectively. Macrolides and sulfonamides were the predominant contaminants and showed the seasonality. Azithromycin had the highest detection frequencies (79.71-100%), followed by roxithromycin (25.71-100%) and erythromycin (21.43-86.96%). The estimated ADD and HRQ for human exposure to antibiotic mixture through drinking-water was less than 0.01 µg/kg/day and 0.01, respectively, which varied over sites, water types, seasons and sex. Ingestion route was more important than dermal contact route (10-6 to 10-4 µg/kg/day magnitude vs. 10-11 to 10-8 µg/kg/day magnitude). Macrolides also contributed mainly to health exposure risks to antibiotics through drinking-water, whose HRQ accounted for 46% to 67% of the total HRQs. Although the individual antibiotic and their combined effects contributed to acceptable health risks for human, the long-term exposure patterns to low-dose antibiotics in drinking-water should not be ignored.

Occurrence, source apportionment and ecological risk assessment of thirty antibiotics in farmland system.

Antibiotics are widely used in medical care, livestock production, and aquaculture. However, antibiotic pollution has attracted increasing global concerns due to their ecological risks after entering into environmental ecosystem via animal excretion, effulent from industrial and domestic sewage treatment facilities. In this study, 30 antibiotics were investigated in soils and irrigation rivers using ultra-performance liquid chromatography-triple quadrupole tandem mass spectrometer. This study evaluated the occurrence, source apportionment, and ecological risks of these target compounds in soils and irrigation rivers (i.e., sediments and water) of farmland system by using principal component analysis-multivariate linear regression (PCA-MLR) and risk quotients (RQ). The concentration range of antibiotics in soils, sediments, and water was 0.38-689.58 ng/g, 81.99-658.00 ng/g, and 134.45-1547.06 ng/L, respectively. In soils, the most abundant antibiotics were quinolones and antifungals with an average concentration of 30.00 ng/g and 7.69 ng/g, respectively, contributing to 40% of total antibiotics. Macrolides were the most frequently detected antibiotics in soils with an average concentration of 4.94 ng/g. In irrigation rivers, quinolones and tetracyclines, the most abundant antibiotics, accounted for 78% and 65% of antibiotics in water and sediments, respectively. Higher antibiotic contamination of irrigation water was primarily distributed in highly populated urban areas, while increasing antibiotic contamination of sediments and soils was particularly observed in rural areas. PCA-MLR analysis indicated that antibiotic contamination in soils was mainly ascribed to the irrigation of sewage-receiving water body and manure application of livestock and poultry farming, which cumulatively contributed to 76% of antibiotics. According to RQ assessment, quinolones in irrigation rivers posed high risk to algae and daphnia, contributing 85% and 72% to the mixture risk, respectively. In soils, macrolides, quinolones and sulfonamides were responsible for more than 90% to the mixture risk of antibiotics. Ultimately, these findings can improve our fundamental knowledge on contamination characteristics and source pathways towards risk management of antibiotics in farmland system.

Evaluation of Mycobacterium Avium Complex Pulmonary Disease Treatment Completion and Adherence to ATS/IDSA Guidelines.

BACKGROUND: Nontuberculous mycobacteria are environmental organisms that cause infections leading to chronic, debilitating pulmonary disease, among which Mycobacterium avium complex (MAC) is the most common species. METHODS: We described patterns of macrolide-based multidrug antibiotic therapies for MAC pulmonary disease (MAC-PD) in US Medicare beneficiaries with bronchiectasis between January 2006 and December 2014. MAC therapy was defined as a multidrug regimen containing a macrolide plus ≥1 other drug targeting MAC-PD (rifamycin, ethambutol, fluoroquinolone, or amikacin) prescribed concomitantly for >28 days. RESULTS: We identified 9189 new MAC therapy users, with a mean age (standard deviation) of 74 (6 years) at the start of therapy; 75% female and 87% non-Hispanic white. A guideline-based regimen (a macrolide, ethambutol, and rifamycin, with or without amikacin) was prescribed for 51% of new MAC therapy users at treatment start, of whom 41% were continuing guideline-based therapy at 6 months, and only 18% at 12 months. Of all new MAC therapy users, by 18 months only 11% were still receiving MAC treatment, 55% had discontinued therapy, and 34% were censored owing to death or the end of the study period. CONCLUSIONS: Overall, nearly half of new MAC therapy users were prescribed a non-guideline-recommended macrolide-based therapy, including regimens commonly associated with promoting macrolide resistance. Treatment discontinuation was common, and once discontinued, only a few beneficiaries resumed therapy at a later time. Our study adds important data to the current literature on treatment patterns for MAC-PD among older US populations. Future research should examine treatment patterns using more contemporary data sources.

Fitness cost of spinosad resistance related to vitellogenin in Frankliniella occidentalis (Pergande).

BACKGROUND: The western flower thrips Frankliniella occidentalis, a worldwide agricultural pest, has developed resistance to an array of insecticides. Spinosad resistance confers an apparent fitness cost in F. occidentalis. In the present study, we compared the reproductive capacities, ovary development, and the expression of the vitellogenin (Vg) gene in spinosad-susceptible (Ivf03) and -resistant (NIL-R) near isogenetic lines of F. occidentalis in order to clarify the reason for the fitness cost in spinosad resistance. RESULTS: The NIL-R strain exhibited a 17.9% decrease in fecundity (eggs laid per female) as compared to the Ivf03 strain, and the ovariole was significantly shortened by 2.8% in the NIL-R strain relative to the Ivf03 strain. Compared to the Ivf03 strain, the expression levels of Vg mRNA and protein were downregulated by 33.7% and 32.9% in the NIL-R strain, respectively. Moreover, interference with the Vg gene significantly reduced the expression levels of Vg mRNA and protein, and decreased ovariole length, survival rates and the fecundity of both strains. CONCLUSION: The results indicate that the downregulated expression of Vg may contribute to the reduction of ovariole length and consequently to a fitness cost in spinosad-resistant F. occidentalis. The results not only increase our understanding of the evolution of insecticide resistance, but also could contribute to the formulation of control strategy of F. occidentalis. © 2022 Society of Chemical Industry.

Assessment of variables associated with prolonged admission duration in children with Mycoplasma pneumoniae pneumonia.

INTRODUCTION: Macrolide-resistant Mycoplasma pneumoniae (MRMP) has become prevalent in children. This study investigated the clinical and laboratory variables of MRMP and macrolide-sensitive M. pneumoniae (MSMP) and identified factors associated with prolonged hospital admission in children. METHODS: A prospective multicenter study was conducted in 1063 children <18 years old in July 2018-June 2020. The 454 had a positive M. pneumoniae polymerase chain reaction assay. RESULTS: Most subjects had MRMP (78.4%), and all mutated strains had the A2063G transition. We defined MRMP* (n = 285) as MRMP pneumonia requiring admission and MSMP* (n = 72) as MSMP pneumonia requiring admission. Patients with MRMP pneumonia were older, more likely to have segmental/lobar pneumonia, and had more febrile days than those with MSMP pneumonia. C-reactive protein (CRP), lactate dehydrogenase (LDH), and percentage neutrophils were more strongly associated with MRMP* than MSMP* groups. Percentage neutrophils, CRP, and alanine aminotransferase significantly changed between admission and follow-up measurements in patients with MRMP* (P < 0.05). The duration of admission positively correlated with the number of febrile days after initiation of antibiotic medication and laboratory variables (white blood cell count, CRP, and aspartate aminotransferase [AST]) (P < 0.05). Random forest analysis indicated that the number of febrile days after initiation of antibiotic medication, AST, and percentage neutrophils at admission was over five. CONCLUSIONS: This study indicated that children with M. pneumoniae pneumonia with a higher number of febrile days after initiation of antibiotic medication, AST, and percentage neutrophils at admission were more likely to have prolonged admission duration.

Occurrence and risk assessment of five kinds of antimicrobial in mattress on swine farm use ectopic fermentation systems in Zhejiang Province.

Mattress is among the main products of ectopic fermentation system (EFS); however, the research on the data of antimicrobial residues in the mattress of EFS and risk assessments of mattress have not been conducted. This study involved a scale survey to assess the levels and distributions of 54 antimicrobial residues, including 4 tetracyclines, 19 quinolones, 22 sulfonamides, 3 amphenicols, and 6 macrolides in mattress on 12 swine farms that use ectopic fermentation systems (EFS) in Zhejiang Province. A total of 25 antimicrobials were detected in mattress, and the total residue amount of antimicrobial in mattress samples of each farm was 0.77-28.2 g/T. Chlortetracycline had the highest contribution rate, and the residue amount of antimicrobial in mattress is not entirely determined by the start-up time of EFS but is related to the use of feed containing antimicrobial, medication habits, the level of mattress management, and maintenance methods of EFS. The risk assessments of antimicrobial in the mattress were carried out. The results show that the risk of using mattress of EFS for soil is low.

Accumulation and risk assessment of antibiotics in edible plants grown in contaminated farmlands: A review.

The extensive occurrence of antibiotics in farmland soil might threaten food safety. The bioaccumulation potential of antibiotics in edible vegetables and crops grown under realistic farming scenarios was reviewed and the human health risk was assessed. A total of 51 antibiotics were documented in 37 species of daily consumed crops. Among different classes of antibiotics, tetracyclines (TCs) exhibited higher residue levels in plants than quinolones (QNs), sulfonamides (SAs), and macrolides (MLs), with median values ranging from 5.10 to 15.4 µg/kg dry weight. The favored accumulation of TCs in plants was probably linked to their relatively higher residual concentrations in soils and greater bioconcentration factors. Compared with the plants grown in open field, accumulation of antibiotics was higher in plant grown under greenhouse condition, probably due to the higher residue levels of antibiotics in the greenhouse soil with intensive application of manure. Cocktails of antibiotics were investigated in potato, corn, carrot, tomato, lettuce, and wheat. Among them, corn exhibited relatively high median concentrations of antibiotics (0.400-203 µg/kg dry weight). Antibiotics tended to accumulate in plant root and their concentrations in fruit were generally low. Risk assessment revealed that human health risk was under the alert line through the daily consumption of antibiotic contaminated vegetables and food crops.

Antibiotics in sewage treatment plants, receiving water bodies and groundwater of Chennai city and the suburb, South India: Occurrence, removal efficiencies, and risk assessment.

The presence of antibiotics in the aqueous environment can alter the water microbiome, inducing antimicrobial resistance genes. Hence, the occurrence of 18 antibiotics belonging to sulfonamides, fluoroquinolones, tetracyclines, phenicols, and macrolides classes were investigated in surface water, groundwater, and sewage treatment plants in Chennai city and the suburbs. Fluoroquinolones had the maximum detection frequency in both influent and effluent samples of urban and suburban STPs, with ofloxacin and ciprofloxacin showing the highest influent concentrations. Erythromycin was the predominant antibiotic in surface water samples with an average concentration of 194.4 ng/L. All the detected antibiotic concentrations were higher in the Buckingham Canal compared to those in Adyar and Cooum rivers, possibly due to direct sewer outfalls in the canal. In groundwater samples, ciprofloxacin showed the highest levels with an average of 20.48 ng/L and the concentrations were comparable to those of surface water. The average sulfamethazine concentration in groundwater (5.2 ng/L) was found to be slightly higher than that of the surface water and much higher than the STP influent concentrations. High levels of ciprofloxacin and sulfamethazine in groundwater may be because of their high solubility and wide use. Moreover, erythromycin was completely removed after treatment in urban STPs; FQs showed relatively lesser removal efficiency (2.4-54%) in urban STPs and (8-44%) in suburban STP. Tetracyclines and phenicols were not detected in any of the samples. Ciprofloxacin and azithromycin in surface water pose a high risk in terms of estimated antibiotic resistance. This study revealed that the measured surface water concentration of antibiotics were 500 times higher for some compounds than the predicted calculated concentrations from STP effluents. Therefore, we suspect the direct sewage outlets or open drains might play an important role in contaminating surface water bodies in Chennai city.

Fitness cost conferred by the novel erm(51) and rpoB mutation on environmental multidrug resistant-Rhodococcus equi.

Rhodococcus equi is a common cause of severe pneumonia in foals. Emergence of macrolide-resistant R. equi isolated from foals and their environment has been reported in the United States. A novel erm(51) gene was recently identified in R. equi in soil from horse farms in Kentucky. Our objective was to determine the effect of the erm(51) gene and associated rpoB mutation on the fitness of multidrug resistant-R. equi (MDR-R. equierm(51)+, rpoB+) under different nutrient conditions. Bacterial growth curves were generated for 3 MDR-R. equierm(51)+, rpoB+ isolates and 3 wild-type (WTN) R. equi isolates recovered from environmental samples of farms in central Kentucky. Growth was measured over 30.5 h in brain-heart infusion broth (BHI), minimal medium (MM), and minimal medium without iron (MM-I). All isolates had significantly (P < 0.05) higher growth in BHI compared to either MM or MM-I. MDR-R. equierm(51)+, rpoB+ exhibited significantly lower growth compared to WTN isolates in BHI (nutrient-rich condition), but not in either MM or MM-I (nutrient-restricted conditions). This study indicates that under nutrient-rich conditions fitness of MDR-R. equierm(51)+, rpoB+ is reduced relative to susceptible isolates; however, under nutrient-restricted conditions MDR-R. equierm(51)+, rpoB+ isolates grow similarly to susceptible isolates. These findings indicate that MDR-R. equierm(51)+, rpoB+ might be outcompeted by susceptible isolates in nature when practices to reduce antimicrobial pressure, such as reducing antimicrobial use in foals, are implemented. But it also raises the concern that these resistant genotypes might persist in the environment of horse-breeding farms in the face of selective pressures such as antimicrobials or nutrient restriction.