Active Ingredient: Amoxicillin
Currently applied methods to detect antibiotic resistant bacteria in sewage fall into two general categories: cultivation-based phenotypic e.
The cultivation based techniques provide proof of viable ARB and standard methods are available e.
Genotypic methods provide evidence of the presence of ARG and can be used in mixed microbial communities.
For a more complete review of current methods and the advantages and disadvantages, the reader is referred to a recent review.
Multiple antibiotic resistance MAR increased over a three year study period in urban wastewater E.
In both of these studies some or all the antibiotics tested showed lower resistance rates in urban wastewater compared to the available human isolate data.
Increased antibiotic use based on sales data has also been linked with higher rates of resistance. For example, in Sweden where vancomycin purchases were known for two hospitals, higher levels of vancomycin-resistant Enterococcus VRE were demonstrated in the sewage from hospitals that purchased five times more vancomycin per hospital bed.
Few studies have attempted to make direct comparisons between AR observed in sewage and AR in the sewage generating population.
Role and relative importance of other sources of antibiotics and ARB in sewers Sewersheds containing hospitals can be expected to have different antibiotic profiles from urban sewage.
In a study in Portugal, the antibiotic profiles detected in hospital sewage compared to residential sewage matched prescription patterns: ciprofloxacin, ofloxacin were higher in hospital sewage and sulfamethoxazole, tetracycline, and penicillin G were higher in raw urban influent.
The relative role of hospital sewage as a source of antibiotics and other pharmaceutical micropollutants has received considerable attention and the reader is referred to other studies and reviews for further information on this topic and state of science regarding the potential necessity for pre-treatment.
Antibiotic data from ref. Urine and fecal matter from patients with infectious diseases can enter sanitary sewers because our wastewater treatment systems are designed to inactivate infectious agents. Generally, hospital effluents have been found to have higher rates of AR and select ARG compared to municipal effluent Table 1.
There have been reports of exceptions to this trend. Higher incidence of resistance in isolates from municipal influent than hospital effluent was reported for 1 E.
For example, while higher incidence of erythromycin resistant Enterococci were observed in hospital effluent, higher incidence of vancomycin resistant Enterococci were observed in municipal sewage in Sweden.
However, these inputs could be amplified if ARB are able to preferentially grow or engage in horizontal gene transfer HGT in sewer systems see section 5.
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