College of Chemistry and Environmental Engineering, Shenzhen University, Shenzhen 518060, China.
State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South Institute of Environmental Science, Ministry of Ecology and Environment, Guangzhou 510530, China.
Sci Total Environ. 2022 Jun 25;827:154171. doi: 10.1016/j.scitotenv.2022.154171. Epub 2022 Feb 26.
Consumption of antibiotics leads to the dissemination of antimicrobial resistance worldwide. Better knowledge of temporal and spatial consumption of antibiotics helps public health authorities to control their usage and combat antimicrobial resistance. However, measuring antibiotic consumption with population surveys, sales data, and production statistics remains challenging due to the complexity of prescription preference, patient compliance, and direct disposal of unused drugs. With the approach of wastewater-based epidemiology (WBE), this study aims to evaluate the consumption of eight commonly-used antibiotics between developed urban and developing sub-urban catchments in China and to characterise the ratios of parent drugs to metabolites in studying the consumption. Seven parent antibiotics were detected in all the wastewater samples (n = 56), whereas some metabolites were detected sporadically. The ratios of parent chemicals to metabolites varied among locations and were often higher than the ratios in pharmacokinetic studies. Estimated consumption of antibiotics ranged from 3.2 ± 2.0 mg/day/1000 inhabitants for trimethoprim to 28,400 ± 7800 mg/day/1000 inhabitants for roxithromycin in the studied catchments. Higher consumption of sulfapyridine, sulfadiazine and roxithromycin was observed in urban than suburban catchments, while consumption of sulfamethoxazole, norfloxacin, and trimethoprim was higher in suburban than in urban catchments. Using the literature data, we found more than 95% reduction of antibiotic use in an urban catchment. Our study revealed the geographical pattern in antibiotic use across different urban and suburban catchments via WBE, and the potential of monitoring parent-to-metabolite ratios for WBE in estimating antibiotic use. These results provide a basis for health authorities to plan different drug-specific control policies between urban and suburban catchments, and for future WBE studies to be aware of other sources, such as animal husbandry and disposals of unused drugs, that can influence the estimated consumption.
抗生素的消费导致了全球范围内抗菌药物耐药性的传播。更好地了解抗生素的时间和空间消费情况有助于公共卫生当局控制其使用并对抗抗菌药物耐药性。然而，由于处方偏好、患者依从性和未使用药物的直接处置的复杂性，通过人群调查、销售数据和生产统计来测量抗生素的消费仍然具有挑战性。随着基于污水的流行病学（WBE）方法的出现，本研究旨在评估中国发达城市和发展中郊区流域中八种常用抗生素的消费情况，并对研究中母药与代谢物的比例进行特征描述。在所有污水样本中均检测到七种母抗生素（n = 56），而一些代谢物则偶尔检测到。母体化学物质与代谢物的比例因地点而异，且通常高于药代动力学研究中的比例。在所研究的流域中，抗生素的估计消费量从 3.2 ± 2.0 mg/天/1000 居民的甲氧苄啶到 28400 ± 7800 mg/天/1000 居民的罗红霉素不等。城市流域中观察到磺胺吡啶、磺胺嘧啶和罗红霉素的消费较高，而磺胺甲恶唑、诺氟沙星和甲氧苄啶的消费在郊区流域中较高。使用文献数据，我们发现城市流域中抗生素的使用减少了 95%以上。我们的研究通过 WBE 揭示了不同城市和郊区流域中抗生素使用的地理模式，以及监测母体-代谢物比例在估计抗生素使用方面的潜力。这些结果为卫生当局在城市和郊区流域之间制定针对特定药物的不同控制政策提供了依据，并为未来的 WBE 研究提供了依据，以了解其他来源，如畜牧业和未使用药物的处置，这些来源可能会影响估计的消费。
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