Special Article - Antibiotic Resistance
J Bacteriol Mycol. 2018; 5(6): 1081.
Prevalence of Antibiotic Resistance among Bacterial Isolates from Hospital Environments and Effluents
Prasad VG, Baliyan S and Sibi G*
Department of Biotechnology, Indian Academy Degree College, Autonomous, Bangalore, India
*Corresponding author: Sibi G, Head, Department of Biotechnology, Indian Academy Degree College, Autonomous, Bangalore, India
Received: September 19, 2018; Accepted: October 10, 2018; Published: October 17, 2018
Intensive use of antibiotics in hospitals provides an environment for antibiotic resistant organisms to flourish, largely unburdened by competition from susceptible organisms. As a result, hospital effluents contribute to the high rate of drug resistant bacteria discharged in the natural environment than domestic wastewater. Understanding the bacterial diversity in hospital wastewater is crucial as hospital acquired infections are an increasing problem. This review presents the microbial population in hospital environments and the identification of antimicrobial resistance strains using non-culture dependent methods reported earlier. In conclusion, the need to assess diversity of microbial population in hospital environment and effluent is required to control the load of antimicrobial drug resistant strains, which would ultimately enter into the environment as biological contaminants.
Keywords: Hospital Waste Water; Antibiotic Resistance; Multidrug Resistant Strains
Antibiotic resistance is an increasing health problem as bacterial infections became lasting longer than ever. Due to the high magnitude of impact caused by antibiotic resistance, significant attention from medical community and researchers is happening over the years. Attention to the effects associated with the spread of resistance while treating the disease is necessary to address the prevalence of antibiotic resistance. Hospital wastewater is a hotspot of diversified bacteria and provides an environment for multi drug resistance due to antibiotics, disinfectants, metabolized drugs from patients’ fluids [1-3] and contributes to the high rate of drug resistant bacteria discharged in the natural environment than domestic wastewater [4-6]. Hospital effluent contains antibiotic residues that are enough to kill susceptible bacteria and at the same time increases the number of resistant bacteria [7-9]. The intensive use of antibiotics in hospitals provides an environment for antibiotic resistant organisms to flourish, largely unburdened by competition from susceptible organisms. Some studies have shown that certain disinfectants and over exposure of hospital bacteria to disinfectants lead to increased antibiotic resistance [10,11]. Antibiotic resistant organisms are capable of causing life threatening infections that are difficult to control due to the limited treatment options. Characterization of bacteria from hospital environments would provide prevalence of antibiotic resistance among them [12,13] and reduces the further development of resistance to common antibiotics.
The levels of antibiotic resistance in hospital wastewater are higher than in urban wastewater due to antibiotic application patterns in hospitals. Understanding the bacterial diversity in hospital wastewater is crucial as hospital acquired infections are an increasing problem. Surveillance of microbiological analysis of hospital wastewater would control antibiotic resistance and nosocomial infections.
A systematic search was carried out in Pub Med, Scopus and Web of Sciences using a combination of Boolean operators. Peer reviewed papers in English on the antibiotic resistance and hospital effluents were retrieved and evaluated based on titles and abstracts. The retrieved papers were managed using Mendeley and the data were consolidated.
Adverse effects of antibiotic resistance
Due to the higher antibiotic consumption in hospitals, the discharge of antimicrobial residues and resistant bacteria in the environment has strong impact on spread of antibiotic resistance. Antibiotic resistance is mediated by diverse resistance genes and it is evident that antibiotic resistance genes can transfer within bacterial communities . These antibiotic resistance genes may either be intrinsic or acquired. Intrinsic resistance is caused in an organism whose innate chromosomal makeup predictable specifies resistance whereas acquired resistance is due to the mutation in its genetic composition. Genes mediating antimicrobial resistance may be found on plasmids, transposes or integrands. The adverse outcomes caused by antibiotic resistant strains mediated infections are higher than the infections caused by susceptible strains . Patients infected with resistant strains require surgical procedures to cure the illness. Extended-spectrum β-lactamase producing strains are associated with higher rates of mortality in patients . High prevalence of antibiotic resistance Neisseria gonorrhoeae strain infection leading to treatment failures and subsequent reproductive tract diseases . The antibiotic resistance in community pathogens has led to increased use of other agents in patients admitted with other infection, introducing additional selection pressure for resistance and adding to hospital costs. The other effects include length of stay in hospitals, morbidity and mortality .
Culture independent approaches
Had examined the bacterial communities using quantitative PCR and 16srRNA gene based pyrosequencing method [19,20]. qPCR was used to determine the presence of microbial contaminants from untreated hospital wastewaters [21,22]. Metagenomics combined with Search Engine for Antimicrobial Resistance (SEAR) is other technique to determine the full length antibiotic resistance genes from aquatic samples [23,24]. Meta transcriptomics can be used to identify the transcripts of antibiotic resistance genes in various samples . Molecular epidemiological investigations involving Antimicrobial Resistance Determinant Microarray was used to determine the antimicrobial resistance in clinically relevant bacterial pathogens .
Antibiotic Resistance Strains in Hospital Environments
A large number of resistant bacteria have been found in the area of hospital wastewater discharge (Table 1) [13,27-55]. Hospital water bacteria seem to play an important role in the dissemination of resistance to antibiotics and the resistance genes are over expressed which is possibly related to the level of antibiotic usage in hospitals .
Aeromonas spp, Kluyvera spp
Picao et al., 2013
Lamba et al., 2017
Anssour et al., 2016
Citrobacter freundii, Enterobacter cloacae, Klebsiella oxytoca, Enterobacter colocae
White et al., 2016
Coliforms and feacel Enterococci
Chitnis et al., 2004
Barraud et al., 2013
Iweriebor et al., 2015
Maheshwari et al., 2016; Lien et al., 2017; Ko et al., 2017
Escherichia coli, Acinetobacter
Wang et al., 2018
Escherichia coli, Citrobacter freundii
Korzeniewska and Harnisz (2013)
Extended spectrum beta lactamase producing bacteria
Walia et al., 2016; Parvez and Khan, 2018
Faecalibacterium, Aeromonas, Prevotella
Varela et al., 2014
Ory et al., 2016
Klebsiella spp, Pseudomonas spp
Moges et al., 2014
Methicillin-resistant S. aureus
Mandal et al., 2015
Proteobacteria, Bacteroidetes, Firmicutes and Actinobacteria.
Szekeres et al., 2017
Kerr and Snelling, 2009; Magalhaes et al., 2016; Miranda et al., 2015; Varin et al., 2017
Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella pneumoniae
Wang et al., 2017
Haller et al., 2018; Santoro et al., 2015
Tsai et al., 1998
Salmonella, Shigella, Staphylococcus aureus, E.coli
Fekadu et al., 2015
Furuhata et al., 2007
Vancomycin resistant Enterocococci
Bonten et al., 1996; Varela et al., 2013
Table 1: Major bacterial isolates/phyla from hospital environment and effluents.
Antibiotic resistant bacteria are more prevalent in hospitals and are released in to the sewage systems and water bodies where transfer of resistant genes occurs. There is a need to assess diversity of microbial population in hospital environment and wastewater to control the load of antimicrobial drug resistant strains, which would ultimately enter into the environment as biological contaminants.
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Citation: Prasad VG, Baliyan S and Sibi G. Prevalence of Antibiotic Resistance among Bacterial Isolates from Hospital Environments and Effluents. J Bacteriol Mycol. 2018; 5(7): 1082.