Secrets of the Hospital Underbelly: Patterns of Abundance of Antimicrobial Resistance Genes in Hospital Wastewater Vary by Specific Antimicrobial and Bacterial Family

作者：Meghan Perry, Hannah C. Lepper, Luke McNally, Bryan A. Wee, Patrick Munk, Amanda Warr, Barbara Moore, Pota Kalima, Carol Philip, Ana Maria de Roda Husman, Frank M. Aarestrup, Mark Woolhouse, Bram van Bunnik · 发表于：Frontiers in Microbiology · 年份：2021 · DOI：10.3389/fmicb.2021.703560 · 被引用次数：75 · 研究领域：Antibiotic Use and Resistance、Antibiotic Resistance in Bacteria、Pharmaceutical and Antibiotic Environmental Impacts

Background: Hospital wastewater is a major source of antimicrobial resistance (AMR) outflow into the environment. This study uses metagenomics to study how hospital clinical activity impacts antimicrobial resistance genes (ARGs) abundances in hospital wastewater. Methods: Sewage was collected over a 24-h period from multiple wastewater collection points (CPs) representing different specialties within a tertiary hospital site and simultaneously from community sewage works. High throughput shotgun sequencing was performed using Illumina HiSeq4000. ARG abundances were correlated to hospital antimicrobial usage (AMU), data on clinical activity and resistance prevalence in clinical isolates. Results: Microbiota and ARG composition varied between CPs and overall ARG abundance was higher in hospital wastewater than in community influent. ARG and microbiota compositions were correlated (Procrustes analysis, p =0.014). Total antimicrobial usage was not associated with higher ARG abundance in wastewater. However, there was a small positive association between resistance genes and antimicrobial usage matched to ARG phenotype (IRR 1.11, CI 1.06–1.16, p <0.001). Furthermore, analyzing carbapenem and vancomycin resistance separately indicated that counts of ARGs to these antimicrobials were positively associated with their increased usage [carbapenem rate ratio (RR) 1.91, 95% CI 1.01–3.72, p =0.07, and vancomycin RR 10.25, CI 2.32–49.10, p <0.01]. Overall, ARG abundance withi...