Surveillance and Risk Assessment of Antibiotic Resistance in the Urban Water Cycle, Le Thai Hoang
1. Surveillance and Risk Assessment
of Antibiotic Resistance in Urban
Water Cycle
Le Thai Hoang, PhD
Lecturer, Environmental Engineering
International University - Vietnam National University HCMC
ProSPER.Net Young Researchers’ School
6 to 15 March, 2017
6. Antibiotic in environment
Antibiotics
Livestock uses Human uses
Excretion
Treatment
of manure
Land application
Excretion Flushing
unused
Topical
application
Municipal WW
Runoff Treated
discharge
Leach to
ground water
Contaminate
surface water
Potential drinking
water sources
7. Why is resistance monitoring
important?
Baseline Spread Trend
Source
tracking
Veterinary/
human use
Risk
factors
Education Policy
10. 10.0 km
Reservoirs & Catchments
Catchments & Reservoirs
K
PKR1 (R)
WQ4A (C)
WQ5 (C)
WQ6 (C)
M
RmbA (R)
CmbB (C)
CmbH (C)
U
RUSA (R)
RUSF (R)
RUSH (R)
FRESHWATER
Mc
RmcA (R)
K U
Mc
M
11. Hospital Wastewater
Hospital wastewater
S6 S7
H1 H2
• Reservoirs for pathogenic bacteria
• High usage of antibiotics
• Concern with transmission and
long term survival in the
environment
• Discharged into domestic sewage
system without any treatments
routes of dissemination to
environment
16. Concentrations of ARB
ARB concentrations (geometric means):
Hospital wastewaters - (1.40 x 105 CFU/mL)
Domestic wastewaters – (5.94 x 105 CFU/mL)
Freshwaters – (5.14 x 102 CFU/mL)
17. Relative abundance of ARGs
Relative abundance of ARGs (geometric means):
Hospital wastewaters – Average (8.91x10-2)
Domestic watewaters – Average (3.62x10-2 )
Freshwaters – Average (8.67x10-4)
1. ARG abundance in freshwaters 2 magnitudes lower
2. All 4 bla-gene targets found in freshwaters (10-5-10-7) , however at least
a magnitude lower than in wastewaters (10-3-10-5)
21. Occurrence of Antibiotic resistant E. coli
<100 CFU/100ml <10,000 CFU/100ml
• Prevalence of E. coli in agricultural and urbanized area > 100 times in reservoirs
• Among 4 reservoirs, Marina is the highest prevalence of AMR E. coli.
• CIP and SXT are the most prevalent. AMK was the least.
• Average concentration of E. coli in reservoirs < EPA guideline (200 EC/100ml).
22. Concentration of E. coli O157H7
Eco CEFT-Eco CIP-Eco SXT-Eco MEM-Eco
Average 108.58 0.02 0.34 1.01 0.05
Median 1.6 0 0.01 0.01 0
Mode 0.04 0 0 0 0
SD 7,537.19 0.23 12.74 91.98 1.08
Distribution lnorm lnorm lnorm lnorm lnorm
E. coli : E. coli O157H7 = 1: 0.08
Reference: Haas et al., 1999; Howard et
al., 2006;
Assumption
AR E. coli : AR E. coli O157H7 = 1:0.08
23. Exposure and dose-response parameters
Distribution Parameters References
Exposure
duration (h)
PERT(minimum, likeliest, maximum) (0.25, 0.5, 2) Mcbridge 2013
Ingestion
rate (ml/h)
PERT(minimum, likeliest, maximum) (2,10, 20)
Dorevitch 2010,
2011
Dose-response model
Beta-poison model: 𝑃𝑃 = 1 − (1 + 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷 ×
2
1
𝛼𝛼−1
𝑁𝑁50
)−𝛼𝛼
Exposure for 2nd contact activities (Rowing, canoeing, kayaking)
alpha N50 illness/infection rate Reference
E.coli O157H7 2.10E-01 1.12E+03 0.35
Hass 1999,
Horward and Pedley 2004
Assumption
Susceptible and resistant E. coli O157H7 have the same ability to infect to human.
25. Number of GI cases per 1000 recreators
2.9%
0.02%
Statistics Eco157 CAZ-Eco157 CIP-Eco157 SXT-Eco157 MEM-Eco157
Mean 4.04 0.00397 0.0317 0.0953 0.00626
Median 0.167 0.000185 0.000817 0.00109 0.000164
Minimum 0.0006 0 0 0 0
Maximum 219 5.49 15.9 69.3 6.49
EPA guideline (2012):
36 illnesses/ 1000 cases
Frequency of exceeding the EPA guideline 2012
26. Removal of Antibiotic Resistance
in Domestic Wastewater by The
Membrane Bioreactor Treatment
Influent
Effluent
Primary
Clarifiers
Anoxic/Aerobic
tank
Secondary
Clarifiers
Return Activated Sludge
Effluent
Primary
Clarifiers
Anoxic/Aerobic
tank
Membrane
Bioreactor
Return Activated Sludge
INF
A1 A2
B1 B2
CAS
treatment
process
MBR
treatment
process
27. Membrane bioreactor treatment
27
• Introduced in late 1960s
• Is the combination of a membrane
process with a suspended
growth bioreactor
• is now widely used for wastewater
treatment.
• Advantages over the activated sludge
treatment:
• high quality of effluent: low turbidity,
bacteria, TSS, BOD
• can operate at high concentration of
MLSS, low reactor volume
OBJECTIVE: To evaluate the removal efficiency of AB, ARB, and
ARG in the MBR process compared to the CAS process.
28. 28
𝑹𝑹𝑹𝑹𝑹𝑹𝑹𝑹𝑹𝑹𝑹𝑹𝑹𝑹 𝒆𝒆𝒆𝒆𝒆𝒆𝒆𝒆𝒆𝒆𝒆𝒆𝒆𝒆 𝒆𝒆𝒆𝒆𝒆𝒆 % =
𝑪𝑪𝑰𝑰𝑰𝑰𝑰𝑰 − 𝑪𝑪 × 𝟏𝟏𝟏𝟏𝟏𝟏
𝑪𝑪𝑰𝑰𝑰𝑰𝑰𝑰
Removal of Antibiotic residues
• On average, about 75% and 80% AB were removed in CAS and
MBR processes.
• Both Secondary clarifier and MBR treatment did not efficiently
remove AB.
ng/l CAS MBR
High
>200
Chlotetracycline Chlotetracycline
Oxytetracycline Amoxicilin
Tetracycline Oxytetracycline
Azithromycin Clarithromycin
Clarithromycin Sulfamethaxazole
Ciprofloxacin Tetracycline
Sulfamethaxazole Ciprofloxacin
Medium
10-200
Trimethoprim Azithromycin
Sulfamethazine Erythromycin
Erythromycin Sulfamethazine
Meropenem Trimethoprim
Lincomycin Meropenem
Vancomycin Lincomycin
Vancomycin
Low
<10
Clindamycin Clindamycin
Minocycline Minocycline
Chloramphenicol Chloramphenicol
Ceftazidime Ceftazidime
Tylosin Tylosin
Amoxicilin
29. 29
Removal of Antibiotic resistant bacteria
• Prevalence of ARB in the effluent were from 102 to 104 CFU/ml in CAS, and under
detection limit in MBR.
• Average log removal of ARB in final effluent were about 2.3 in CAS, and 5.5 in MBR.
• MBR treatment was highly efficient in removal of ARB.
𝑳𝑳𝑳𝑳𝑳𝑳 𝒓𝒓𝒓𝒓𝒓𝒓𝒓𝒓𝒓𝒓𝒓𝒓𝒓𝒓 (𝑨𝑨𝑨𝑨𝑨𝑨) = −log𝟏𝟏𝟏𝟏
𝑪𝑪
𝑪𝑪𝑰𝑰𝑰𝑰𝑰𝑰
*
*
P=0.016
P=2.5x10-9
30. 30
• Average log removal of ARG were approximately 1.5
in CAS, and 3.0 in MBR.
• Compared to the CAS, MBR showed a better
efficiency in removal of ARG genes.
CFU/ml CAS MBR
High
>1000
16S 16S
sul1 sul1
tetO tetO
aac6
int1
ermB
Medium
<1000
qnrB ermB
blaCTX-M qnrB
tetM blaCTX-M
blaSHV tetM
blaKPC
Low
<100
qnrA qnrA
vanA int1
dfrA vanA
sul2 dfrA
cfr blaKPC
blaNDM1 aac6
sul2
cfr
blaSHV
blaNDM1
*
Removal of Antibiotic resistant genes
31. Overall summary
∗ Antibiotic resistance (AB, ARB, ARG) is already a global
concern threatening environmental and community
health, not something in future.
∗ Surveillance effort, especially on aquatic environment,
need to be raised worldwide to understand the current
status, baseline, and guideline for further management.
∗ Culture-based method, qPCR, LC-MSMS, and
metagenomics are demonstrated a good method to
detect and analyze AR.
∗ There need to be a specific treatment of AR in WWTP to
increase removal of AR factors (AB, ARB, ARG)
∗ Burden of disease for AR pathogen needs to evaluate.
32. Acknowledgements
A/Prof. Karina Gin
Dr. Ng Charmaine
Dr. Laurence Haller
National Research Foundation (NRF)
International University HCMC
RCE ESD Southern Vietnam