Nolasco-Rojas Andres E, Cruz-Del-Agua Eder, Cruz-Cruz Clemente, Loyola-Cruz Miguel Ángel, Ayil-Gutiérrez Benjamín A, Tamayo-Ordóñez María C, Tamayo-Ordoñez Yahaira de J, Rojas-Bernabé Araceli, Tamayo-Ordoñez Francisco A, Durán-Manuel Emilio M, Paredes-Mendoza Marianela, Márquez-Valdelamar Laura M, Jiménez-Zamarripa Carlos A, Ocharan-Hernández Esther, Zárate-Segura Paola B, García-Hernández Omar, Sosa-Hernández Oscar, Vásquez-Jiménez Enzo, Calzada-Mendoza Claudia C, Bello-López Juan M
Hospital Juárez de México, Mexico City 07760, Mexico.
Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico.
Pathogens. 2025 Apr 23;14(5):402. doi: 10.3390/pathogens14050402.
Hospital wastewater (HWW) is a major source of microbiological contamination, often released into the municipal sewage system without prior treatment. This HWW may contain pathogens with antimicrobial resistance, posing risks to public health. The aim of this work was to assess the risks associated with the seasonal release of ESKAPE bacteria resistant to β-lactam antibiotics and the release of carbapenems and cephalosporins through HWW of Hospital Juárez de México. The 12-month seasonal variation in β-lactam-resistant bacterial populations was assessed in the HWW of five discharge points. Resistant isolates were identified by mass spectrometry (MALDI-TOF) coupled with PCR assays to search for antimicrobial resistance genes, while β-lactamic antibiotics were detected using high-performance liquid chromatography (HPLC). Finally, a double-entry Vester matrix was constructed to classify the problems of HWW according to their degree of causality. Seasonal differences in bacterial loads were observed, with higher levels in warmer months. A wide variety of resistant pathogens were identified, including ESKAPE bacteria, as well as emerging bacteria carrying β-lactamase-encoding genes. The release of meropenem was detected most commonly, followed by cefepime and ceftazidime. The Vester matrix allowed the identification of critical clinical and environmental scenarios where two discharge points contribute significantly to the spread of microbiological contamination. This study highlights the importance of proper management of HWW and the need for stricter regulations to reduce the risks associated with the release of resistant pathogens with health impacts.
医院废水（HWW）是微生物污染的主要来源，通常未经预处理就排入城市污水系统。这种医院废水可能含有具有抗微生物耐药性的病原体，对公众健康构成风险。这项工作的目的是评估墨西哥华雷斯医院通过医院废水季节性排放对β-内酰胺抗生素耐药的ESKAPE细菌以及碳青霉烯类和头孢菌素类排放所带来的风险。在五个排放点的医院废水中评估了对β-内酰胺耐药细菌群体的12个月季节性变化。通过质谱分析（MALDI-TOF）结合PCR检测来鉴定耐药菌株，以寻找抗微生物耐药基因，同时使用高效液相色谱法（HPLC）检测β-内酰胺类抗生素。最后，构建了一个双项维斯特矩阵，根据因果程度对医院废水问题进行分类。观察到细菌负荷存在季节性差异，温暖月份的水平较高。鉴定出了多种耐药病原体，包括ESKAPE细菌以及携带β-内酰胺酶编码基因的新出现细菌。美罗培南的排放检测最为常见，其次是头孢吡肟和头孢他啶。维斯特矩阵有助于识别关键的临床和环境场景，其中两个排放点对微生物污染的传播有重大影响。这项研究强调了妥善管理医院废水的重要性以及制定更严格法规以降低与释放具有健康影响的耐药病原体相关风险的必要性。
