Antibiotics and antibiotic-resistant bacteria in waters associated with a hospital in Ujjain, India

<p>Abstract</p> <p>Background</p> <p>Concerns have been raised about the public health implications of the presence of antibiotic residues in the aquatic environment and their effect on the development of bacterial resistance. While there is information on antibiotic residue levels in hospital effluent from some other countries, information on antibiotic residue levels in effluent from Indian hospitals is not available. Also, concurrent studies on antibiotic prescription quantity in a hospital and antibiotic residue levels and resistant bacteria in the effluent of the same hospital are few. Therefore, we quantified antibiotic residues in waters associated with a hospital in India and assessed their association, if any, with quantities of antibiotic prescribed in the hospital and the susceptibility of <it>Escherichia coli </it>found in the hospital effluent.</p> <p>Methods</p> <p>This cross-sectional study was conducted in a teaching hospital outside the city of Ujjain in India. Seven antibiotics - amoxicillin, ceftriaxone, amikacin, ofloxacin, ciprofloxacin, norfloxacin and levofloxacin - were selected. Prescribed quantities were obtained from hospital records. The samples of the hospital associated water were analysed for the above mentioned antibiotics using well developed and validated liquid chromatography/tandem mass spectrometry technique after selectively isolating the analytes from the matrix using solid phase extraction. <it>Escherichia coli </it>isolates from these waters were tested for antibiotic susceptibility, by standard Kirby Bauer disc diffusion method using Clinical and Laboratory Standard Institute breakpoints.</p> <p>Results</p> <p>Ciprofloxacin was the highest prescribed antibiotic in the hospital and its residue levels in the hospital wastewater were also the highest. In samples of the municipal water supply and the groundwater, no antibiotics were detected. There was a positive correlation between the quantity of antibiotics prescribed in the hospital and antibiotic residue levels in the hospital wastewater. Wastewater samples collected in the afternoon contained both a higher number and higher levels of antibiotics compared to samples collected in the morning hours. No amikacin was found in the wastewater, but <it>E.coli </it>isolates from all wastewater samples were resistant to amikacin. Although ciprofloxacin was the most prevalent antibiotic detected in the wastewater, <it>E.coli </it>was not resistant to it.</p> <p>Conclusions</p> <p>Antibiotics are entering the aquatic environment of countries like India through hospital effluent. In-depth studies are needed to establish the correlation, if any, between the quantities of antibiotics prescribed in hospitals and the levels of antibiotic residues found in hospital effluent. Further, the effect of this on the development of bacterial resistance in the environment and its subsequent public health impact need thorough assessment.</p

Efficiency of a constructed wetland for retention of sediment associated phosphorus

A constructed wetland (2.1 ha; 2% of catchment area) in southeast Sweden, in a catchment with 35% arable land on clay soils, was investigated with respect to phosphorus (P) retention, focusing on particulate P (PP) and sediment accretion. The aims were to i) estimate P retention and identify the dominating retention processes; ii) investigate how well estimates of P retention based on inflow-outflow measurements compared with the amount of P accumulated in the sediment. In- and outflow of P was measured during four years with continuous flow measurements and flow proportional weekly composite samples. P in the accumulated sediment was estimated based on core samples and analyzed using sequential fractionation. Total P load during four years was 65 kg/ha and intensive sampling events detected 69% as PP. Based on inflow-outflow estimates the mean P retention was 2.8 kg/ha/yr, or 17%, but the amount of P accumulated in the inlet zone  equated 78% of the TP load. This discrepancy showed the need to add studies of sediment accumulation to inflow-outflow estimates for an improved understanding of the P retention. The dominating P forms in the sediment were organic P (38%) and P associated with iron or aluminum (39%), i.e. potentially mobile forms. In areas colonized by Typha latifolia, the amount of P in the upper sediment layer (390 kg) was more than double the total P load of 136 kg. Cycling and release in those areas is a potential source of P that deserves further attention.The original publication is available at www.springerlink.com:Karin Johannesson, Jonas Andersson and Karin Sundblad-Tonderski, Efficiency of a constructed wetland for retention of sediment associated phosphorus, 2011, Hydrobiologia, (674), 1, 179-190.http://dx.doi.org/10.1007/s10750-011-0728-yCopyright: Springer Science Business Mediahttp://www.springerlink.com

Linköping University Post Print Antibiotics and antibiotic-resistant bacteria in waters associated with a hospital in Ujjain, India Antibiotics and antibiotic-resistant bacteria in waters associated with a hospital in Ujjain, India

Abstract Background: Concerns have been raised about the public health implications of the presence of antibiotic residues in the aquatic environment and their effect on the development of bacterial resistance. While there is information on antibiotic residue levels in hospital effluent from some other countries, information on antibiotic residue levels in effluent from Indian hospitals is not available. Also, concurrent studies on antibiotic prescription quantity in a hospital and antibiotic residue levels and resistant bacteria in the effluent of the same hospital are few. Therefore, we quantified antibiotic residues in waters associated with a hospital in India and assessed their association, if any, with quantities of antibiotic prescribed in the hospital and the susceptibility of Escherichia coli found in the hospital effluent. Methods: This cross-sectional study was conducted in a teaching hospital outside the city of Ujjain in India. Seven antibiotics -amoxicillin, ceftriaxone, amikacin, ofloxacin, ciprofloxacin, norfloxacin and levofloxacin -were selected. Prescribed quantities were obtained from hospital records. The samples of the hospital associated water were analysed for the above mentioned antibiotics using well developed and validated liquid chromatography/tandem mass spectrometry technique after selectively isolating the analytes from the matrix using solid phase extraction. Escherichia coli isolates from these waters were tested for antibiotic susceptibility, by standard Kirby Bauer disc diffusion method using Clinical and Laboratory Standard Institute breakpoints. Results: Ciprofloxacin was the highest prescribed antibiotic in the hospital and its residue levels in the hospital wastewater were also the highest. In samples of the municipal water supply and the groundwater, no antibiotics were detected. There was a positive correlation between the quantity of antibiotics prescribed in the hospital and antibiotic residue levels in the hospital wastewater. Wastewater samples collected in the afternoon contained both a higher number and higher levels of antibiotics compared to samples collected in the morning hours. No amikacin was found in the wastewater, but E.coli isolates from all wastewater samples were resistant to amikacin. Although ciprofloxacin was the most prevalent antibiotic detected in the wastewater, E.coli was not resistant to it. Conclusions: Antibiotics are entering the aquatic environment of countries like India through hospital effluent. Indepth studies are needed to establish the correlation, if any, between the quantities of antibiotics prescribed in hospitals and the levels of antibiotic residues found in hospital effluent. Further, the effect of this on the development of bacterial resistance in the environment and its subsequent public health impact need thorough assessment