Deedat Fatima Zahra, Faya Andile Mbuso, Gumbi Bhekumuzi Prince, Johnston Deanne Mary Graham, Karpoormath Rajshekhar, Essack Sabiha Yusuf
Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa.
Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
JAC Antimicrob Resist. 2025 May 12;7(3):dlaf070. doi: 10.1093/jacamr/dlaf070. eCollection 2025 Jun.
To analyse the possible association between hospital antibiotic use and residual antibiotic concentrations in wastewater effluents, with the aim of evaluating wastewater surveillance as a potential alternative antimicrobial use monitoring system (AlAUMS).
The study was conducted at a Regional Hospital in South Africa and followed an observational, quantitative and correlational design. The hospital use of selected antibiotics was determined using consumption data as a proxy and calculated using the WHO Anatomic Therapeutic Chemical (ATC) and DDD methodology. Selected antibiotics in the hospital effluent were analysed by solid-phase extraction (SPE) and quantified by GC-MS. Spearman's rank correlation coefficient and values were calculated to determine the possible association between antibiotic use and residual antibiotic concentrations as an AlAUMS.
The highest mean antibiotic use in the hospital was for oral sulfamethoxazole (6.71 DDD/100 bed days), followed by parenteral cefazolin (3.15 DDD/100 bed days). The highest mean antibiotic concentration in the hospital effluent was for sulfamethoxazole (34.57 μg/L) followed by cefazolin (25.32 μg/L). A strong positive correlation was observed for sulfamethoxazole (s = 0.86) and a moderate positive correlation for cefazolin (s = 0.50). However, none were statistically significant.
The positive correlation displayed between the use of cefazolin and sulfamethoxazole and their concentrations in wastewater indicates a potential association between antibiotic use and residual antibiotic concentrations in hospital settings suggesting that wastewater surveillance is a promising proxy for conventional antibiotic use surveillance. Further studies are necessary to validate these results before wastewater surveillance can be implemented as an AlAUMS.
分析医院抗生素使用与废水排放中残留抗生素浓度之间的可能关联，旨在评估废水监测作为一种潜在的替代抗菌药物使用监测系统（AlAUMS）。
该研究在南非一家地区医院进行，采用观察性、定量和相关性设计。使用消费数据作为替代指标确定医院对选定抗生素的使用情况，并采用世界卫生组织解剖治疗化学（ATC）和限定日剂量（DDD）方法进行计算。通过固相萃取（SPE）分析医院废水中选定的抗生素，并通过气相色谱 - 质谱联用（GC-MS）进行定量。计算斯皮尔曼等级相关系数和 值，以确定抗生素使用与作为AlAUMS的残留抗生素浓度之间的可能关联。
医院中平均抗生素使用量最高的是口服磺胺甲恶唑（6.71 DDD/100床日），其次是肠外注射头孢唑林（3.15 DDD/100床日）。医院废水中平均抗生素浓度最高的是磺胺甲恶唑（34.57μg/L），其次是头孢唑林（25.32μg/L）。磺胺甲恶唑呈现出强正相关（s = 0.86），头孢唑林呈现出中等正相关（s = 0.50）。然而，均无统计学意义。
头孢唑林和磺胺甲恶唑的使用与其在废水中的浓度之间呈现的正相关表明，医院环境中抗生素使用与残留抗生素浓度之间存在潜在关联，这表明废水监测是传统抗生素使用监测的一个有前景的替代方法。在废水监测能够作为AlAUMS实施之前，需要进一步研究来验证这些结果。
