Abstract
Antimicrobial resistance is a major public health concern. Carbapenemase-producing Enterobacterales (CPE) represent a significant health threat as some strains are resistant to almost all available antibiotics. The aim of this research was to examine hospital effluent and municipal wastewater in an urban area in Ireland for CPE. Samples of hospital effluent (n = 5), municipal wastewater before (n = 5) and after (n = 4) the hospital effluent stream joined the municipal wastewater stream were collected over a nine-week period (May–June 2017). All samples were examined for CPE by direct plating onto Brilliance CRE agar. Isolates were selected for susceptibility testing to 15 antimicrobial agents in accordance with EUCAST criteria. Where relevant, isolates were tested for carbapenemase-encoding genes by real-time PCR. CPE were detected in five samples of hospital effluent, one sample of pre-hospital wastewater and three samples of post-hospital wastewater. Our findings suggest hospital effluent is a major contributor to CPE in municipal wastewater. Monitoring of hospital effluent for CPE could have important applications in detection and risk management of unrecognised dissemination of CPE in both the healthcare setting and the environment.
Highlights
Antimicrobial resistance is a major public health concern worldwide
Our findings suggest hospital effluent is a major contributor to Carbapenemase-producing Enterobacterales (CPE) in municipal wastewater
142 isolates of Enterobacterales were collected from hospital effluent (n = 65, 46%), pre-hospital (n = 31, 22%) and post-hospital wastewater (n = 46, 32%) samples
Summary
Antimicrobial resistance is a major public health concern worldwide. It is by no means a new phenomenon, it is one which is continuously escalating (CDC, 2013; WHO, 2018). In May 2015, the World Health Assembly developed a global action plan to tackle the problem of antimicrobial resistance (AMR) (WHO, 2015). In June 2017, the European Commission published the EU One Health Action Plan against AMR which builds on the EU Action plan against AMR previously launched in 2011. The new action plan against AMR advocates a one health approach, and highlights the importance of the environment, human health and animal health interconnection (European Commission, 2017). In October 2017, the Irish government published Ireland's National Action Plan on Antimicrobial Resistance 2017–2020 (Department of Health, 2017), and CPE was declared a public health emergency
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