Antibiotic Resistance in Municipal Wastewater: A Special Focus on Hospital Effluents
Hospital effluents contain a hazardous amalgam of drug residues and infectious agents. Qualitative and quantitative evidence shows that hospital effluents are enriched in antibiotics, multidrug-resistant bacteria, antibiotic resistance genes and genetic v
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Contents 1 Introduction 2 Antibiotic Residues 2.1 Antibiotic Residues in Hospital Effluents 2.2 Challenges in Quantification of Antibiotic Residues in Hospital Effluents 2.3 Occurrence of Antibiotics in Hospital Effluents 3 Antibiotic-Resistant Bacteria (ARB) 3.1 ARB in Hospital Effluents 3.2 Methods to Detect ARB and Commonly Used Susceptibility Testing Method 3.3 Occurrence of ARB in Hospital Effluents 4 Antibiotic Resistance Genes (ARGs) 4.1 ARGs in Hospital Effluents 4.2 Application of High-Throughput qPCR (HT-qPCR) to Measure ARGs and MGE 4.3 Prevalent ARGs and MGEs in Hospital Wastewaters Globally and Comparisons with Other Water Sources 5 Resistomes and Mobile Genetic Elements (MGEs) 5.1 Uncovering Resistomes by Metagenomics
C. Ng Environmental Health Institute, National Environment Agency, Singapore, Singapore H. Chen National University of Singapore, Department of Civil and Environmental Engineering, Singapore, Singapore N. H. Tran and L. Haller NUS Environmental Research Institute, National University of Singapore, Singapore, Singapore K. Y.-H. Gin (*) National University of Singapore, Department of Civil and Environmental Engineering, Singapore, Singapore NUS Environmental Research Institute, National University of Singapore, Singapore, Singapore e-mail: [email protected] Celia M. Manaia, Erica Donner, Ivone Vaz-Moreira, Peiying Hong (eds.), Antibiotic Resistance in the Environment: A Worldwide Overview, Hdb Env Chem, DOI 10.1007/698_2020_471, © Springer Nature Switzerland AG 2020
C. Ng et al. 5.2 Identifying MGEs 5.3 Examples of the Application of Metagenomics to AMR Monitoring in Hospital Wastewaters 5.4 Targeted Metagenomics for Qualitative and Quantitative Resistome Analysis 5.5 Other OMIC Strategies to Study ARG Expression Levels in Hospital Wastewaters 6 Curbing the Spread of AMR 7 Possible Treatment Technologies of Hospital Wastewaters 8 Conclusion References
Abstract Hospital effluents contain a hazardous amalgam of drug residues and infectious agents. Qualitative and quantitative evidence shows that hospital effluents are enriched in antibiotics, multidrug-resistant bacteria, antibiotic resistance genes and genetic vectors which could facilitate the horizontal transfer of these genes. This chapter provides an overview of the current status of antimicrobial resistance (AMR) surveillance in hospital effluents and draws comparisons to other AMR monitoring studies in domestic wastewaters and natural aquatic environments. We discuss approaches and standard tools that have been used to measure levels of AMR contamination and provide insights to the latest developments in the detection and profiling of AMR which have yet to gain traction in present surveillance programs. Keywords Antibiotic residues, Antibiotic resistance genes, Antibiotic resistant bacteria, Hospital effluent, Resistome
Abbreviations AMR ARB ARGs CLSI CRB ESBL EUCAST GC HPLC-MS/MS HT-qPCR MGE MGEs MLST qPCR SPE VRE WHO
Antimicrobial resistance Antibiotic-resistant bacteria Antibiotic resistance genes Clinical and Laboratory Standards Instit
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