FACULTY OF SCIENCE

DEPARTMENT OF MICROBIOLOGY
A
SEMINAR PRESENTATION
ON
ANTIBIOTIC RESISTANCE IN MUNICIPAL WASTEWATER: A
SPECIAL FOCUS ON HOSPITAL EFFLUENTS
BY
OYETADE BARAKAT FOLASHADE
MATRIC NUMBER: 170807021
 OUTLINE

• INTRODUCTION
• HOSPITAL EFFLUENTS
• ANTIBIOTICS
• ANTIBIOTIC RESIDUES
• MECHANISMS OF ANTIBIOTIC RESISTANCE
• ANTIBIOTIC RESISTANT BACTERIA
• ANTIBIOTIC RESISTANT GENES
• HOSPITAL WASTEWATER TREATMENT
• CONCLUSION
 INTRODUCTION
Wastewater includes any type (e.g,
from agriculture, domestic means,
industries, human excretion,
commercial sectors,
pharmaceuticals, healthcare units) of
water which quality has been
deteriorated under anthropogenic
influence.
 INTRODUCTION

 Hospitals play a critical role in human health

and medical research.

 Hospital wastewater are generated based on

the size, units and activities that takes place
in the hospital.
 INTRODUCTION
A hospital in developed country generates

400 -1200 L wastewater per bed per day

whereas for developing countries the value

is 200-400 L/capita/day as compared to 100-

400 L/capita/day of domestic wastewater

generation (K. Mishra 2016; E. Carraro 2016).

 HOSPITAL EFFLUENTS
 Highly complex
 Reservoirs of antibiotics
 Reservoirs of antibiotic resistant bacteria
 Reservoirs of antibiotic resistant genes
 Hospital wastewater contained approximately
25% more antibiotics than communal
wastewater (CWW)
 ANTIBIOTICS
 The father of modern chemotherapy is believed to
be Paul Ehrlich who discovered the first antibiotic
named Salvarsan in 1909.
 Gerhard Domagk discovered the sulfa drugs in the
1930s.
 Penicillin discovery made by Alexander Fleming
followed in the 1940s.
 Fleming predicted that the overuse of penicillin
may lead to resistance development and he noted
that it should be used with caution.
 ANTIBIOTICS
 Antibiotics are microbial products, their
derivatives, semi-synthetic or synthetic agents
used systematically that inhibits or kills
susceptible bacteria.
 One of the most successful and important drugs
used in therapeutic application.
 It is estimated that the global antibiotic
consumption increased by 65% over a period of
16 years between 2000 and 2015 (Klein et al.
2018).
 Indiscriminate use has lead to the emergence of
ARBs, and ARGs.
Fig 1. Various antibiotics target sites
Source: Valsamatzi-Panagiotou et al., 2020
ANTIBIOTIC RESIDUE IN HOSPITAL WASTEWATER

 The occurrence multiple classes of antibiotics in hospital

effluents has been well documented.
 Adegbe et al., 2019 reported the presence of amoxicillin
in a study conducted on a teaching hospital's effluents in
Nigeria.
 Ajibola et al., 2020 reported the presence of norflaxin,
ciproflaxin and ofloxacin in two Nigerian hospital
wastewater.
 In hospital effluents in Singapore, Le et al., 2016 found
the presence of macrolides, fluoroquinolones,
sulfonamides, beta- lactams, lincosamides, tetracycline
and trimethoprim
MECHANISMS OF ANTIBIOTIC RESISTANCE
 can arise both from mutations in the pre-existing
genome of a bacterium and from the uptake of
foreign DNA (Larsson and Flach, 2021).
 It falls in four major categories. These are:
• limiting uptake of a drug
• modifying a drug target
• inactivating a drug
• drug efflux (Reygaert, 2018).
Fig: 2 Antibiotic resistance mechanism
Source: Valsamatzi-Panagiotou et al., 2020
ANTIBIOTIC RESISTANCE
BACTERIA
Different studies have shown the presence of
antibiotic resistant bacteria in hospital waste
water including superbugs. The following are
those published on the WHO priority list.
 Extended-spectrum β-lactamase-producing
Escherichia coli (ESBLEc)
 Multidrug-resistant Pseudomonas aeruginosa
 Vancomycin-resistant enterococci (VRE)
 Acinetobacter baumannii
Fig.3 : Kirby-Bauer disc diffusion method for antimicrobial
susceptibility testing of Pseudomonas aeruginosa
Source: Bhatt et al.,2015
Table 1: Some major antibiotic resistant bacterial isolates found in the
hospital environment from different countries.
Multidrug resistant Bacteria Methods of identification

Vancomycin-resistant Enterococci Microbiological, biochemical, RAPD, and 16S

rRNA sequencing

MDR E. coli, S. aureus Biochemical finger printing and/or random

amplification of polymorphic DNA (RAPD)-
PCR

Methicillin-resistant S. aureus, vancomycin- Biochemical tests, PCR, and sequencing

resistant S. aureus

Source: Kaur et al (2020)

Fig: 4. Antimicrobial susceptibility testing on Vancomycin
resistant Enterococcus faecalis
Source: Sah et al., 2017
 ANTIBIOTIC RESISTANT GENES
 HWW presents more types of ARGs, and their
abundance is higher than those in most
wastewater systems.
 Resistance genes to carbapenems,
sulfonamides, tetracyclines and mobile
genetic elements were found at high relative
abundance.
 The abundance of resistance genes to
extended-spectrum β-lactams, carbapenems,
sulfonamides and glycopeptide significantly
decreased, while tetracycline resistance genes
abundance increased from 2014 to 2018.
HOSPITAL WASTEWATER TREAMENT
 Most hospitals discharge their waste
directly into municipal wastewater
treatment plant where they are
treated alongside domestic
wastewater.
 Some discharge waste water into
streams and rivers
 A few have on-site treatment plants.
 HOSPITAL WASTEWATER TREATMENT
The removal efficiencies of advanced
technologies in on-site treatment facilities have
been reported in various research. This
technologies includes:
• Membrane bioreactor
• Ozonation
• Activated carbon
• UV treatment.
Fig 5: Pharmafilter Installation and Process Steps
Source: Paulus et al., 2019
 CONCLUSION
The study of hospital effluents is very
important to understand and monitor
the spread and development of
antibiotic resistance and subsequent
changes in treatment efficiencies.
THANK YOU FOR LISTENING.