Multidrug-resistant bacteria in the wastewater of the hospitals in Port Harcourt metropolis: Implications for environmental health

Document Type : Original Article

Authors

Department of Microbiology, University of Port Harcourt, P.M.B. 5323, Choba, Nigeria

Abstract

Dissemination of antibiotic resistance via aquatic systems is considered to be an important environmental health concern. The present study aimed to assess the levels of multidrug-resistant bacteria in the raw wastewater of two hospitals in Port Harcourt metropolis using standard microbiological techniques. Among 64 bacterial isolates, seven bacterial groups were identified, including Klebsiella pneumoniae, Escherichia coli, Enterobacter, Staphylococcus aureus, Citrobacter, Shigella, and Bacillus. The bacterial counts were within the ranges of 7.8 x 104-4.8 x 106 and 6.9 x 104-1.09 x 105 CFU/ml in hospitals A and B, respectively. The obtained results indicated high resistance to quinolones/fluoroquinolones (83.3-90%) and penicillins (50-70%). In addition, 86.9% of the isolates showed multidrug resistance. The multiple antibiotic resistance (MAR) index was within the range of 0.1-0.8 in the gram-positive bacteria and 0.1-0.6 in the gram-negative bacteria. The findings confirmed the presence of bacteria with high MAR indices in the untreated hospital wastewater.

Keywords


1. WHO. Antimicrobial Resistance: Global report on Surveillance. Geneva: WHO, 2014.
2. Centre for Disease Control and Prevention, CDC. Antibiotic resistance threats in the United States. Washington: U.S. Department of Health and Human Services Centres for Disease Control and Prevention, 2013: 12-9.
3. Dzidic S, Bedekovic V. Horizontal gene transfer-emerging multidrug resistance in hospital bacteria. Acta Pharm Sin 2003; 24(6): 519-26.
4. Fletcher S. Understanding the contribution of environmental factors in the spread of antimicrobial resistance. Environ Health Prev Med 2015; 20: 243-52.
5. Emmanuel E, Perrodin Y, Keck G, Blanchard J, Vermande P. Effects of hospital wastewater on aquatic ecosystem. XXVIII Congreso Interamericano de Ingeniería Sanitaria y Ambiental Cancún, México 2002; 27-31.
6. Novo A, André S, Viana P, Nunes OC, Manaia CM. Antibiotic resistance, antimicrobial residues and bacterial community composition in urban wastewater. Water Res 2013; 47: 1875-87.
7. Kümmerer K, Henninger A. Promoting resistance by the emission of antibiotics from hospitals and household into effluent. Clin Microbiol Infect 2003; 9(12): 1203-14.
8. Servais P, Passerat J. Antimicrobial resistance of fecal bacteria in waters of Seine river watershed (France). Sci Total Environ 2009; 408(2): 365-72.
9. Kümmerer K. Antibiotics in the aquatic environment – A review – part II. Chemosphere 2009; 75(4): 435-41.
10. Bengtsson-Palme J, Kristiansson E, Joakim Larsson DG. Environmental factors influencing the development and spread of antibiotic resistance. FEMS Microbiol Rev 2018; 42(1): 68-80.
11. Andremont A, Walsh TR. The role of sanitation in the development and spread of antimicrobial resistance – Antimicrobial Resistance and the Environment; AMR Control, 2015. Retrieved from: http://resistancecontrol.info/wp-content/uploads/2017/07/10_Andremont-Walsh.pdf
12. APHA, American Public Health Association. Standard Methods for the Examination of Water and Wastewater. 20th Ed. APHA, Washington D.C, 1996.
13. Cheesbrough M. Discrete Laboratory Practice in Tropical Countries, Part 1. 2nd ed. United Kingdom: Press Syndicate of the University of Cambridge, 2005: 472-490.
14. Murray P. Manual of Clinical Microbiology. Washington DC: ASM press, 2003.
15. CLSI, Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 21st Informational Supplement, CLSI Document M100-S21, Pennsylvania, USA, 2011.
16. Miller RA, Walker RD, Baya A, Clemens K, Coles M, Hawke JP, et al. Antimicrobial susceptibility testing of aquatic bacteria: Quality control disk diffusion ranges for Escherichia coli ATCC 25922 and Aeromonas salmonicida subsp. salmonicida ATCC 33658 at 22 and 28 oC. J Clin Microbiol 2003; 41(9): 4318-23.
17. Yechouron A, Dascal A, Stevenson J, Mendelson J. Ability of national committee for clinical laboratory standards-recommended quality control strains from the American Type culture collection to detect errors in disk diffusion susceptibility tests. J Clin Microbiol 1991; 29(12): 2758-62.
18. Blasco MD, Esteve C, Alcaide E. Multidrug resistant waterborne pathogens isolated from water reservoirs and cooling systems. J Appl Microbiol 2008; 105(2): 469-75.
19. Ahn Y, Choi J. Bacterial communities and antibiotic resistance communities in a full-scale hospital wastewater treatment plant by high-throughput pyrosequencing. Water 2016; 8(12): 580.
20. Galvin S, Boyle F, Hickey P, Vellinga A, Morris D, Cormican M. Enumeration and characterization of antimicrobial-resistant Escherichia coli bacteria in effluent from municipal, hospital, and secondary treatment facility sources. Appl Environ Microbiol 2010; 76(14): 4772-9.
21. Asfaw T, Negash L, Kahsay A, Weldu Y. Antibiotic resistant bacteria from treated and untreated hospital wastewater at Ayder Referral Hospital, Mekelle, North Ethiopia. Adv Microbiol 2017; 7(12): 871-86.
22. Obayiuwana A, Ogunjobi A, Yang M, Ibekwe M. Characterisation of bacterial communities and their antibiotic resistance profiles in wastewaters obtained from pharmaceutical facilities in Lagos and Ogun States, Nigeria. Int J Environ Res Public Health 2018; 15(7): 1365.
23. Mustapha A, Imir T. Detection of multi-drug resistant Gram negative bacteria from hospital sewage in North East Nigeria. Front Environ Microbiol 2019; 5(1): 1-7.
24. Eze CT, Onwurah INE. Environmental Health Risk Assessment of Hospital Wastewater in Enugu Urban, Nigeria. Proceedings of the 14th International Conference on Environmental Science and Technology, Rhodes, Greece, 3-5 September 2015.
25. Fekadu S, Merid Y, Beyene H, Teshome W, Gebre-Selassie S. Assessment of antibiotic- and disinfectant-resistant bacteria in hospital wastewater, South Ethiopia: A cross-sectional study. J Infect Dev Ctries 2015; 9(2): 149-56.
26. Magiorakos AP, Srinivasan A, Carey RB, Carmelli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for acquired resistance. Clin Microbiol Infect 2012; 18(3): 268-81.
27. Odjadjare EEO, Igbinosa EO, Mordi RM, Igere B, Igeleke CL, Okoh AI. Prevalence of multiple antibiotics resistant (MAR) Pseudomonas species in the final effluents of three municipal wastewater treatment facilities in South Africa. Int J Environ Res Public Health 2012; 9(6): 2092-107.
28. Delgado-Gardea CE, Tamez-Guerra P, Gomez-Flores R, Zavala-Díaz de la Serna F J, Eroza-de la Vega G, Nevárez-Moorillón GV, et al. Multidrug-resistant bacteria isolated from surface water in Bassaseachic Falls National Park, Mexico. Int J Environ Res Public Health 2016; 13(6): 597.
29. Wang H, Dzink-Fox JL, Chen M, Levy SB. Genetic characterization of highly fluoroquinolone-resistant clinical Escherichia coli strains from China: Role of acrR mutations. Antimicrob Agents Chemother 2001; 45(5): 1515-21.
30. Oteo J, Aracil B, Hoyo JF, Perianes J, Gómez-Garcés JL, Alós JI. Do the quinolones still constitute valid empirical therapy for community-acquired urinary tract infections in Spain? Clin Microbiol Infect 1999; 5: 654-6.
31. Katouli M, Thompson J M, Gündodu A, Stratton H M. Antibiotic Resistant Bacteria in Hospital Wastewaters and Sewage Treatment Plants. Paper presented at the Science Forum and Stakeholder Engagement: Building Linkages, Collaboration and Science Quality Conference.  [Retrieved from http://www.urbanwateralliance.org.au/ publications/forum2012/, Accessed 02 January, 2018].
32. Thompson JM, Gündoğdu A, Stratton HM, Katouli M. Antibiotic resistant Staphylococcus aureus in hospital wastewaters and sewage treatment plants with special reference to methicillin-resistant Staphylococcus aureus (MRSA). J Appl Microbiol 2012; 114(1): 44-54.
33. Bashir-Raho G, Abouni B. Escherichia coli and Staphylococcus aureus most common source of infection. Volume 5. In: Méndez-Vilas A, editor. The Battle against Microbial Pathogens: Basic Science, Technological Advances and Educational Programs. Badajoz, Spain: Formatex Research Centre, 2015.
34. Rath S, Padhy RN. Prevalence of two multi-drug resistant Klebsiella species in an Indian teaching hospital and adjoining community. J Infect Public Health 2014; 7(6): 496-507.
35. Odjadjare EEO, Ekrakene T. Molecular detection and antibiogram characterization of Staphylococcus aureus strains isolated from urine samples in a tertiary hospital based in Benin City, Nigeria. BIU J Basic Appl Sci 2016; 2(1): 1-12.
36. Huijbers PMC, Blaak H, De Jong MC. Role of the environment in the transmission of antimicrobial resistance to humans: A review. Environ Sci Technol 2015; 49(20): 11993-2004.
37. Jutkina J, Rutgersson C, Flach CF, Larsson DGJ. An assay for determining minimal concentrations of antibiotics that drive horizontal transfer of resistance. Sci Total Environ 2016; 548-549: 131-8.