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The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues
Authors:AM Voigt  HA Faerber  G Wilbring  D Skutlarek  C Felder  R Mahn  D Wolf  P Brossart  T Hornung  S Engelhart  M Exner  RM Schmithausen
Affiliation:1. Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany;2. Medical Clinic, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany;3. University Clinic V, Dpt. Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria;4. Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
Abstract:Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L?1 to a maximum of 79?mg·L?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.
Keywords:Antibiotic residues  Clinical wastewater  LC-MS/MS  Biofilm  Antibiotic selection pressure  AMOX  amoxicillin  AMP  ampicillin  AZI  azithromycin  CEFA  cefaclor  CEFO  cefotaxime  CEFT  ceftazidime  CEFU  cefuroxime  CIP  ciprofloxacin  CLA  clarithromycin  CLIN  clindamycin  CTC  chlortetracycline  CLOX  cloxacillin  DDD  defined daily doses  DICLOX  dicloxacillin  DOC  doxycycline  ERY  erythromycin  dh-ERY  dehydrato-erythromycin  ENRO  enrofloxacin  ESBL  extended-spectrum beta-lactamase  FLU  flucloxacillin  LOQ  limit of quantification  LIN  linezolid  GLASS  Global Antimicrobial Resistance Surveillance System  MERO  meropenem  METHI  methicillin  METRO  metronidazole  MEZLO  mezlocillin  MIC  minimal inhibition concentration  MOX  moxifloxacin  MDRO  multi drug resistant organisms  NAF  nafcillin  OFLOX  ofloxacin  OXA  oxacillin  OTC  oxytetracycline  PEN-G  penicillin G  PEN-V  penicillin V  PIP  piperacillin  PNEC  predicted no effect concentration  RDD  recommended daily dose  ROX  roxithromycin  STP  sewage treatment plant  SH  shower drain  SI  sink siphon  SPIR  spiramycin  SCP  sulfachlorpyridazine  SDZ  sulfadiazine  SDMX  sulfadimethoxine  SDMD  sulfadimidine  SDX  sulfadoxine  SEP  sulfaethoxypyridazine  SMZ  sulfamerazine  SMX  sulfamethoxazole  N4AcSMX  N4-Acetylsulfamethoxazole  SMP  sulfathiazole  STZ  sulfamethoxypyridazine  TC  tetracycline  TMP  trimethoprim  TYL  Tylosin  US-CDC  US Center for Disease Control and Prevention  WC  water closet  WHO  World Health Organization  VANC  vancomycin
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