Department of Chemistry, Faculty of Science, University of Bath, Bath BA2 7AY, UK.
Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China.
Water Res. 2022 Aug 15;222:118942. doi: 10.1016/j.watres.2022.118942. Epub 2022 Aug 2.
Wastewater-based epidemiology (WBE) has potential to identify the epidemiological links between people, animals, and the environment, as part of antimicrobial resistance (AMR) surveillance. In this study, we investigated six wastewater treatment plants (WWTPs) serving six communities located in two regions in Eastern China: Site A in Zhejiang and site B in Jiangsu province to assess the public use of antimicrobial agents (AA). Fifty antimicrobials and 24 of their metabolites were quantified using ultraperformance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS). Spatiotemporal trends were established for measured concentrations, daily loads, and population-normalised daily loads. Daily AA mass loads varied between 1.6 g/day and 324.6 g/day reflecting the WWTP scales, with macrolides and β-lactams showing the highest overall environmental burden at 223.7 g/day and 173.7 g/day, respectively. Emissions of antibiotic residues from manufacturing have been observed, with the peak daily load 12-fold higher than the overall load from a community serving a population of over 600,000. Community exposure levels of 225.2 ± 156.2 mg/day/1000 inhabitant and 351.9 ± 133.5 mg/day/1000 inhabitant were recorded in site A and B, respectively. Paired parent-metabolites analysis identified a large proportion (64-78%) of un-metabolised metronidazole and clindamycin at site B, indicating improper disposal of unused drugs either in the community or in livestock production. Consumption levels, calculated via WBE, suggested relatively low antimicrobial usage in Eastern China compared to other areas in China. This first application of WBE in Eastern China to assess the community-wide exposure to AAs has potential to inform regional antimicrobial stewardship.
基于污水的流行病学（WBE）有可能确定人与动物和环境之间的流行病学联系，作为抗生素耐药性（AMR）监测的一部分。在这项研究中，我们调查了中国东部两个地区的六个污水处理厂（WWTP）为六个社区提供服务：浙江的 A 点和江苏的 B 点，以评估公众使用抗生素的情况（AA）。使用超高效液相色谱-三重四极杆串联质谱法（UPLC-MS/MS）定量测定了 50 种抗生素及其 24 种代谢物。建立了测量浓度、日负荷和人口归一化日负荷的时空趋势。日 AA 质量负荷在 1.6 g/天至 324.6 g/天之间变化，反映了 WWTP 的规模，大环内酯类和β-内酰胺类的环境总负担最高，分别为 223.7 g/天和 173.7 g/天。已经观察到抗生素残留从制造中排放，峰值日负荷比服务于 60 多万人口的社区的总负荷高 12 倍。在 A 点和 B 点，分别记录到社区暴露水平为 225.2 ± 156.2 mg/天/1000 居民和 351.9 ± 133.5 mg/天/1000 居民。配对的母体-代谢物分析表明，在 B 点，大部分（64-78%）未代谢的甲硝唑和克林霉素未经代谢，这表明未使用的药物要么在社区中，要么在畜牧业生产中被不当处理。通过 WBE 计算的消费水平表明，与中国其他地区相比，中国东部的抗生素使用相对较低。这是在中国东部首次应用 WBE 评估 AA 的社区广泛暴露情况，有可能为区域抗生素管理提供信息。
