Risk assessment of infectious diseases in rural population associated with chronic exposure to sub-therapeutic concentrations of antibiotics in environment.

Abstract

Background: Various antibiotics are being continuously added in different environmental compartments from point and non-point sources. The rural settings are more vulnerable to this addition. Since, antibiotics are very sensitive compound which are also degraded in natural environment spontaneously as well as by means of microbial activity. Therefore, the concentrations of antibiotics reported in these compartments are perhaps below WHO regulatory limits but chronic exposure to these sub-therapeutic concentrations may cause antimicrobial resistance (AMR). The resistant microorganisms are potential threat in rural population that cause various infectious diseases in them. Aims:This study aimed to (i) assess the indirect exposure of rural population to antibiotics, (ii) assess the effect of exposure on human gut microbiome, and (iii) assess the risk of infectious diseases in exposed rural population.Method:Agricultural soil, sewage water, livestock waste, poultry waste and human feces samples in triplicate were collected fortnightly for three months and analyzed for ciprofloxacin and Co-amoxiclav (target antibiotics) through HPLC. Population exposure to antibiotics in rural population was characterized using self-structured questionnaire included livestock handlers, poultry workers, agricultural farmers, female households and children (n=300). Human fecal samples were also collected to assess the AMR in their gut microbiome against the target antibiotics. Results: Ciprofloxacin and Co-amoxiclav were estimated at concentration ranging between 0.90 and 3.88 ng/L in sewage water, 0.6 and 2.68 μg/kg in Agricultural soil, 1.12 and 3.82 μg/kg in livestock waste, 0.92 and 3.51 μg/kg in poultry waste and 0.65 and 1.41 μg/kg in human feces. Conclusion:Based upon antibiotic resistance percentages against target antibiotics, low risk of E.coli related infections in households and children, moderate risk in agricultural farmers and high risk in poultry workers and livestock handlers were concluded.