Department of Water Protection Engineering and Environmental Microbiology, Faculty of Geoengineering, University of Warmia and Mazury in Olsztyn, Prawocheńskiego 1, 10-720 Olsztyn, Poland.
Int J Environ Res Public Health. 2022 Oct 25;19(21):13868. doi: 10.3390/ijerph192113868.
Hospitals are regarded as ecological niches of antibiotic-resistant bacteria (ARB). ARB can spread outside the hospital environment via hospital wastewater (HWW). Therefore, HWW is often disinfected in local stations to minimize that risk. Chlorine-based treatment is the most popular method of HWW disinfection around the world, however, recent research has suggested that it can contribute to the spread of antimicrobial resistance (AMR). The aim of this study is to determine the impact of HWW disinfection on the clonal similarity of Enterobacteriaceae species and their ability to produce extended-spectrum beta-lactamases (ESBLs). The study was conducted in a hospital with a local chlorine-based disinfection station. Samples of wastewater before disinfection and samples of disinfected wastewater, collected in four research seasons, were analyzed. Bacteria potentially belonging to the Enterobacteriaceae family were isolated from HWW. The Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) method was used to generate DNA fingerprints of all bacterial isolates. The isolates were phenotypically tested for the production of ESBLs. Antibiotic resistance genes (, , and , , , and ) were detected by PCR in strains with confirmed phenotypic ability to produce ESBLs. The ESBL+ isolates were identified by the sequencing of 16S rDNA. In the present study, the same bacterial clones were isolated from HWW before and after disinfection and HWW was sampled in different seasons. Genetic and phenotypic variations were observed in bacterial clones. ESBL+ strains were isolated significantly more often from disinfected than from non-disinfected HWW. The gene was significantly more prevalent in isolates from disinfected than non-disinfected HWW. and were the dominant species in ESBL+ strains isolated from both sampling sites. The results of this study indicate that chlorine-based disinfection promotes the survival of ESBL-producing bacteria and/or the transmission of genetic determinants of antimicrobial resistance. As a result, chlorination increases the proportion of ESBL-producing Enterobacteriaceae in disinfected wastewater. Consequently, chlorine-based disinfection practices may pose a risk to the environment and public health by accelerating the spread of antimicrobial resistance.
医院被认为是抗生素耐药菌（ARB）的生态小生境。ARB 可以通过医院废水（HWW）在医院环境之外传播。因此，HWW 通常在当地站点进行消毒，以最大程度地降低风险。基于氯的处理是世界范围内 HWW 消毒最流行的方法，但是，最近的研究表明，它可能会助长抗微生物药物耐药性（AMR）的传播。本研究的目的是确定 HWW 消毒对肠杆菌科物种的克隆相似性及其产生扩展谱β-内酰胺酶（ESBLs）的能力的影响。该研究在一家具有本地基于氯的消毒站的医院中进行。分析了消毒前和四个研究季节收集的消毒后废水样品。从 HWW 中分离出可能属于肠杆菌科的细菌。使用肠杆菌重复基因间一致性聚合酶链反应（ERIC-PCR）方法生成所有细菌分离物的 DNA 指纹。对所有分离物进行表型测试，以检测 ESBL 的产生。通过 PCR 在表型上确认具有产生 ESBL 能力的菌株中检测到抗生素耐药基因（，，和，，，和）。通过 16S rDNA 测序鉴定 ESBL+分离株。在本研究中，从消毒前后的 HWW 以及不同季节的 HWW 中分离出相同的细菌克隆。在细菌克隆中观察到遗传和表型变异。从消毒后的 HWW 中分离出 ESBL+菌株的频率明显高于非消毒后的 HWW。与非消毒后的 HWW 相比，基因在消毒后的 HWW 中的分离株中更为普遍。和是从两个采样点分离出的 ESBL+菌株中的主要物种。本研究的结果表明，基于氯的消毒促进了产生 ESBL 的细菌的存活和/或抗微生物耐药性遗传决定因素的传播。因此，氯化增加了消毒废水中产生 ESBL 的肠杆菌科的比例。因此，基于氯的消毒实践可能通过加速抗微生物药物耐药性的传播对环境和公共健康构成威胁。
