Are hospital wastewater treatment plants a source of new resistant bacterial strains?

To understand which type of hospital waste may contain the highest amount of antibiotic resistant microorganisms that could be released into the environment, the bacterial strains entering and leaving a hospital wastewater treatment plant (HWTP) were identified and tested for their antibiotic susceptibility. To achieve this goal, samples were collected from three separate sites, inlet and outlet wastewater positions, and sludge generated in a septic tank. After microbiological characterization according to APHA, AWWA, and WEF protocols, the relative susceptibility of the bacterial strains to various antibiotic agents was assessed according to the Clinical and Laboratory Standards Institute guidelines, to determine whether there were higher numbers of resistant bacterial strains in the inlet wastewater sample than in the outlet wastewater and sludge samples. The results showed more antibiotic resistant bacteria in the sludge than in the inlet wastewater, and that the Enterobacteriaceae family was the predominant species in the collected samples. The most antibiotic-resistant families were found to be Streptococcacea and non-Enterobacteriaceae. Some bacterial strains were resistant to all the tested antibiotics. We conclude that the studied HWTP can be considered a source of resistant bacterial strains. It is suggested that outlet water and sludge generated in HWTPs should be monitored, and that efficient treatment to eliminate all bacteria from the different types of hospital waste released into the environment is adopted.

Using photocatalyzed-peroxonization to disinfect and denature genetic material of bacterial plasmids present in hospital wastewater.

The literature reports the presence of multiresistant microorganisms in wastewater discharged from municipal and hospital wastewater treatment plants (WWTPs). This has led to questions concerning the disinfection efficiency of the treatments applied. Thus, this study aimed to assess the efficiency of different chemical oxidation methods to disinfect and to degrade bacterial plasmids present in hospital wastewaters, to avoid the dispersion of antibiotic resistance genes in the environment. The methods tested were UV254nm alone or associated with an Ag or Ti-photocatalyst in photo-peroxonization (UV254 nm/H2O2/O3/Ag2O/Ag2CO3@PU or UV254 nm/H2O2/O3/TiO2@PU) under different pH conditions (4, 7, and 10). The application of plasmid DNA electrophoresis to hospital wastewater treated using an advanced oxidation process (AOP) achieved the total structural denaturation of microorganism plasmids at the three pH values tested. Also, UV254 nm alone was partially efficient in the disinfection of hospital wastewater. AOPs performed with the two functionalized catalysts resulted in 100% disinfection after 10 min at the three pH values tested. No intact plasmids were observed after 20 min of treatment with photocatalysis. This study could contribute to the development and improvement of wastewater treatment aimed at mitigating the spread of multiresistant microorganisms in the environment.

Characterization of bacterial resistance in treated hospital wastewater.

This article seeks to characterize the bacterial profile of pediatric hospital wastewater samples collected at the outlet of a wastewater treatment plant, and to estimate their relative susceptibility to antimicrobial agents. A total of 64 strains were isolated in the wastewater samples, of which 49 were identified as belonging to different families: Enterobacteriaceae (e.g. Escherichia coli, Klebsiella sp., Citrobacter sp.) comprised 57.2% of the identified bacteria, non-Enterobacteriaceae (e.g. Aeromonas sp., Pseudomonas sp.) comprised 30.6%, and Streptococcaceae (e.g. Enterococcus sp.) comprised 12.2%. The tests of the susceptibility of the bacteria to the antimicrobial agents used in the hospital showed that 100% of the bacterial species found discharged in the hospital wastewater treatment system were resistant to one or more of the antimicrobial agents according to the criteria of the U.S. Clinical Laboratory Standards Institute/National Committee for Clinical Laboratory Standards. The antimicrobial agent tests showed that meropenem, norfloxacin, ciprofloxacin, levofloxacin, and cefepime were the most effective antimicrobials against bacteria of the Enterobacteriaceae family. For bacteria of the non-Enterobacteriaceae family, norfloxacin, ciprofloxacin, levofloxacin, and cefepime presented the most effective antimicrobial action, whereas for bacteria of the Streptococcaceae family, ampicillin, vancomycin, and gentamicin were the most effective antimicrobials. Hospital wastewater treatment plants could be considered as places of selection pressure for bacterial resistance because of the presence of antibiotic-resistant bacteria coming from sewers or created at the treatment plant.