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Impact of effluent parameters and vancomycin concentration on vancomycin resistant Escherichia coli and its host specific bacteriophage lytic activity in hospital effluent.

Vancomycin resistance in bacteria has been classified under high priority category by World Health Organization (WHO) and its presence in hospital effluent is reported to be increasing owing to excess antibiotics use. Among various strategies, bacteriophage has been recently considered as a promising biological agent for combating such antimicrobial resistant bacteria (ARB). However, the influence of effluent's properties on phage-ARB interaction in actual hospital effluent is not completely understood. The present works intends to study this influence of hospital effluent and its parameters on the interaction between vancomycin resistant E. coli (VRE) and its host specific bacteriophage. The isolated VRE was identified by 16S rRNA sequencing, matrix-assisted laser desorption/ionization-time of flight (MALDI - TOF) and whole genome sequencing. The infectivity of phage onto host bacteria was investigated using electron microscopic techniques, dynamic light scattering (DLS), spectrofluorophotometer and confirmed using double agar overlay method. The monovalency and polyvalency of isolated phage against various bacterial species were determined. The phage morphology was identical to T7 phage belonging to Podoviridae. The phage lysis was maximum at pH 7 (90.2%), 37 °C (91.6%) and vancomycin concentration of 50 μg/mL in both synthetic media (89.13%) and effluent (100%). At a maximum vancomycin concentration of 100 μg/mL, decrease in Ca, K, Mg and P (up to 19.70, 14.18, 28, and 15.82% respectively) concentration in effluent was observed due to phage infectivity when compared to control. The whole genome sequencing was performed and the bioinformatics analysis presented the role of mdfA gene encoding the efflux pump in causing vancomycin resistance in E. coli. It also depicted the presence of multiple genes responsible for mercury, cobalt, zinc and cadmium resistance in VRE. These results clearly indicate that bacteriophage mediated combating of VRE is possible in actual hospital effluent and can be used as one of the treatment methods.

Vancomycin

Drug resistant Klebsiella pneumoniae from patients and hospital effluent: a correlation?

BACKGROUND: The application of wastewater-based epidemiology has gained traction as a cost effective tool in antimicrobial resistance (AMR) surveillance with studies showing a correlation between the presence of resistant bacteria from hospital sewage and patients. This study compared Klebsiella pneumoniae from patients and hospital effluent in terms of antibiotic resistance patterns, antibiotic resistance genes (ARGs), mobile genetic elements (MGEs) and phylogenomic relationships. RESULTS: Pooled effluent samples were collected from the final effluent point of a regional hospital and K. pneumoniae isolates were identified on selective media. Clinical isolates were also collected from the same hospital. Antimicrobial susceptibility testing (AST) was performed using the VITEK® 2 system. DNA was extracted prior to whole genome sequencing (WGS). The resistome, mobilome, and phylogenetic lineages of sequenced isolates were assessed using bioinformatics analysis. A total of 10 randomly selected presumptive and 10 clinical K. pneumoniae constituted the sample and were subjected to AST. Total resistance was observed in the clinical samples to cefuroxime, cefotaxime, piperacillin/tazobactam, gentamicin, tobramycin and trimethoprim/sulfamethoxazole. The effluent isolates exhibited total susceptibility to most antibiotics but showed resistance to amoxicillin/clavulanic acid and piperacillin/tazobactam (100%), and tigecycline (10%). The effluent isolates did not exhibit a diverse resistome, while the clinical isolates harboured genes conferring resistance to aminoglycoside (aph(6)-Id, aph(3'')-Ib, aac(6')-Ib-cr, aadA16), ß-lactam (blaSVH group, blaOXA group, blaTEM group), and fluoroquinolone (oqxA, oqxB) antibiotics. Only class 1 integrons were identified. Phylogenetic analysis revealed that effluent isolates from this study were not closely related to the clinical isolates. CONCLUSION: This study showed no correlation between the resistance profiles of the clinical and effluent isolates. The relationship between AMR in hospital effluent and clinical resistance may depend on the antimicrobial agents and bacterial species studied.

Klebsiella pneumoniae

Municipal sewage as a pathway for multidrug-resistant KPC-producing Klebsiella pneumoniae from hospital effluent to urban stream: challenges for wastewater management.

Carbapenemase-producing Klebsiella pneumoniae is among the mainly reasons for death from bacterial infection associated with antibiotic resistance. Its widespread dissemination, especially due to KPC enzyme, is one of the main challenges in One Health perspective. Here, we studied 42 KPC-producing K. pneumoniae isolates from hospital wastewater, municipal wastewater from wastewater treatment plant (WWTP), and urban stream which receives treated municipal effluent. The isolates presented broad resistance to β-lactams antibiotics, as well as to fluoroquinolones, and show antibiotic resistance profile very similar, even those from out-of-hospital settings. Along to blaKPC gene, blaCTX-M-1 (33,3 %, n = 14), blaCTX-M-8 (19 %, n = 8), qnrB (52,3 %, n = 22), qnrS (2,38 %, n = 1), and rmtB (19 %, n = 8) were detected. There was a predominance of gene that confers tolerance to silver and copper metals, as well as to virulence factor related to enterobactin and colibactin production. Macrorestriction genomic analysis by XbaI enzyme demonstrated several pulsotype, but some ones are related. Isolates from hospital wastewater were detected after 4 months at the same sampling point, as well as similar to those detected in WWTP and urban stream demonstrating the effluents role as spreaders of antibiotic resistance. This study provides data on the characterization of KPC-producing K. pneumoniae, which contributes to the epidemiological characterization of human pathogens transmitted by aquatic matrices. In view of the universal sanitation and control of antimicrobial resistance in the One Health perspective, greater investment in effluent treatment is necessary to avoid contamination and environmental dissemination of antibiotic-resistant bacteria.

Klebsiella pneumoniae

The role of immunoassay in the analysis of microcontaminants in water samples.

Concentrations of natural and synthetic steroids and an anticancer drug (methotrexate) have been determined in water by adapting established immunoassay procedures. The limits of detection for the assays used were 10 ng/liter for norethisterone, 5 ng/liter for ethinyl estradiol and progesterone, and 6.25 ng/liter for methotrexate. Results below the level of detection were obtained in all the samples examined (8 river samples and 6 potable supply samples) except for 2 river samples (17 ng/liter) for norethisterone, and 1 river sample and 1 potable water sample for progesterone (6 ng/liter). A concentration of 1 microgram/liter of methotrexate was found in a sample of hospital effluent. There appears to be no evidence of adverse effects from reused water resources which may be contaminated from the normal use of such highly active therapeutic agents.

Ethinyl Estradiol

[Waste water pollutants due to the use of disinfectants in the hospital].

It is assumed that the antiseptic effect of disinfectants in effluents from hospitals can severely disturb the growth of microorganisms in the different stages of aeration of sewage plants. Regular biological catabolism could therefore be damaged. The impact of substances on the waste water depends on the concentration of disinfectants they contain. Consequently this essay first examines the expected quantities of antiseptic substances in the effluent of a medium-sized hospital (440 Beds). The effluents treated here however showed a low concentration of disinfectants and it could be proved that these quantities do not have any harmful effects on the examined parameters such as BOD (Biochemical Oxygen Demand), COD (Chemical Oxygen Demand) and pH-value.

Disinfectants

The epidemiological relationship between Salmonella isolated from poultry meat and sewage effluents at a long-stay hospital.

Between February 1988 and March 1989 chicken carcases delivered to the kitchen of a long stay psycho-geriatric hospital were screened every week for salmonella contamination. While 214 of 477 (45%) individual carcases carried one or more salmonella types, every single consignment examined contained affected carcases. Simultaneously, sewers draining the residential accommodation and excluding kitchen effluent, were also monitored. Thirty out of 79 (38%) of Moore's swabs were positive for salmonella. There was a statistically significant association between the salmonella types isolated from chicken and those isolated from sewers the following week. Following a change in kitchen policy to order only cooked chicken there was a significant reduction in the isolation of salmonella from the sewers.

Animals

Early discharge after modified radical mastectomy.

Thirty-nine patients underwent modified radical mastectomy and were discharged with their suction drains and sutures in place after a mean postoperative stay of 4.7 days. Drains and sutures were removed at the first office visit. There were no infections, and late seromas developed in only 21 percent of the patients. Another group of patients were hospitalized until drainage effluent from their tubes was less than 30 ml/day, at which time the drains were removed and the patients discharged. This group had a mean postoperative stay of 9.5 days, and an incidence of late seroma of 43 percent. These data suggest it is both safe and effective to discharge patients 3 to 5 days after mastectomy at considerable potential cost savings due to the reduced hospital stay.

Adult

Environmental antibiotic contamination and AMR: Integrating pathways, impacts, and artificial intelligence-driven mitigation.

The widespread contamination of the environment with antibiotic residues is a significant factor contributing to the global crisis of antimicrobial resistance (AMR). Antibiotics from various sources, such as effluents from municipal and hospital wastewater treatment plants, agricultural runoffs, discharges from pharmaceutical manufacturing and improper disposal of expired or unused medicines, create selective pressures in the spread of antibiotic resistance genes. These environmental reservoirs act as hotspots for horizontal gene transfer, facilitating the emergence of multidrug-resistant pathogens. Conventional detection methods including culture-based assays, chromatographic quantification, and molecular diagnostics, provide essential insights but are limited by low throughput, reduced sensitivity to new Antibiotic Resistance Genes, and challenges in real-time monitoring across complex environments. Recent advances, such as whole-genome sequencing, metagenomics, and biosensor-based detection, help to address these gaps by enabling more comprehensive surveillance of the resistome. Artificial intelligence further enhances these approaches by improving data interpretation and pattern recognition, thus complementing traditional and molecular methods rather than replacing them. This review examines the pathways of environmental antibiotic contamination, ecological and health impacts of AMR, and limitations of conventional detection methods. It aims to clarify how these pathways contribute to the AMR crisis, assess the effectiveness of existing surveillance techniques, and identify gaps in current research.

Anti-Bacterial Agents

The use of wall suction as a lipoaspirator.

Hospital wall suction, standard tubing, and liposuction cannulas have been used successfully for liposuction. Benefits include convenience, simplicity, cost effectiveness, and reduction of effluent dispersion. Our experiences indicates that hospital wall suction can be used as an efficacious lipoaspirator.

Humans

Radio-iodine in thyroid glands of swans, farm animals and humans, also in algae and river water from the Thames Valley, England.

A highly sensitive counting system has been used to measure radio-iodine in environmental samples from the Thames Valley. Iodine-125 and occasionally iodine-131 have been found in the thyroid glands of most of the swans that have died on the River Thames, the River Wey and the Grand Union Canal, and in algae and water samples from the Thames and many of its tributaries. The presence of this activity is ascribed to the waste discarded into the drainage system by hospitals and research laboratories, reaching the rivers via the effluent from sewage treatment works. The Thames is used as a source of drinking water, particularly in London and its western approaches. Weed and water samples collected from river water abstraction points, reservoirs, tap water supplies, and animal water troughs fed from this supply all contained low levels of iodine-125. The drinking water route can account for the iodine-125 found in the thyroids of farm animals from west Surrey and in a few people living in London. The amounts found constitute a trivial radiation dose to man and animals as they are far below the acceptable limit of exposure for man.

Animals

Effect of water temperature on bacterial killing in laundry.

The increasing cost of energy directed our attention to testing the feasibility of low temperature washing. Hospital laundries use formulated chemicals at high temperature wash waters of 66 degrees C. Wash water effluents and fabric bacterial counts of heavily soiled linen were correlated with alkalinity and temperature measurements to investigate the bacterial killing action of hot and cold wash formulas. Terry towels were found to be contaminated with 10(7) to 10(9) organisms per 100 cm2 at the beginning of the washing process. The most common gram-negative rods found were Klebsiella, Enterobacter and Serratia species. Staphylococci were the predominant gram-positives. Both cold and hot water washing including the bleach cycle reduced bacterial counts in fabric by 3 log10. Similarly wash water cfu/mL mL declined 3 to 4 log10. A further 0.5 to 1.0 log10 reduction was effected in the 93.3 degrees C drying cycle. Low temperature wash formulas were comparable to high temperature laundry with respect to bacterial counts and species. Cold water formulas at 31.1 degrees C offer an alternative method to reduce energy consumption and maintain bacteriological and esthetic linen quality.

Bacteria

Drug resistance of coliform bacteria in hospital and city sewage.

The number and properties of drug-resistant coliform bacteria in hospital and city sewage were compared. There was little difference in the counts of organisms with nontransferable resistance to one or more of 13 commonly used drugs. An average of 26% of coliforms in hospital waste water had transferable resistance to at least one of the drugs ampicillin, chloramphenicol, streptomycin, sulfonamide, or tetracycline as compared to an average of 4% in city sewage. R(+) bacteria in the hospital discharge were also resistant to a broader spectrum of drugs than those in city sewage. In both effluents, the occurrence of fecal Escherichia coli among R(+) coliforms was twice as high as among coliforms with nontransferable resistance. Resistance was transferable to Salmonella typhi, and such drug-resistant pathogens in the water environment could be of particular concern. The significance of the results with regard to environmental pollution with R(+) bacteria and the dissemination of these organisms is discussed.

Anti-Bacterial Agents

Presence of human immunodeficiency virus nucleic acids in wastewater and their detection by polymerase chain reaction.

The human immunodeficiency virus type 1 (HIV-1) released by infected individuals or present in human and hospital wastes can potentially cause contamination problems. The presence of HIV-1 was investigated in 16 environmental samples, including raw wastewater, sludge, final effluent, soil, and pond water, collected from different locations. A method was developed to extract total nucleic acids in intact form directly from the raw samples or from the viral concentrates of the raw samples. The isolated nucleic acids were analyzed for the presence of HIV-1 by using in vitro amplification of the target sequences by the polymerase chain reaction (PCR) method. HIV-1-specific proviral DNA and viral RNA were detected in the extracted nucleic acids obtained from three wastewater samples by this method. The specificity of the PCR-amplified products was determined by Southern blot hybridization with an HIV-1-specific oligonucleotide probe, SK19. The isolated nucleic acids from wastewater samples were also screened for the presence of poliovirus type 1, representing a commonly found enteric virus, and simian immunodeficiency virus, representing, presumably, rare viruses. While poliovirus type 1 viral RNA was found in all of the wastewater samples, none of the samples yielded a simian immunodeficiency virus-specific product. No PCR-amplified product was yielded when wastewater samples were directly used for the detection of HIV-1 and poliovirus type 1. The wastewater constituents appeared to be inhibitory to the enzymes reverse transcriptase and DNA polymerase.(ABSTRACT TRUNCATED AT 250 WORDS)

Base Sequence

Primary anastomosis in emergency distal colonic surgery after on-table colonic lavage.

The traditional operative management of emergency distal colon pathology has involved staged procedures, but recently Hartmann's operation has gained popularity. The indications for primary anastomosis without covering colostomy have remained controversial, but the technique of on-table lavage has extended the use of this approach in the acute setting. A series of seven patients having this procedure for diverticular abscess (three), obstructing colonic carcinoma (one), perforating colonic carcinoma (one) and sigmoid volvulus (two) is presented. The saline irrigation is introduced by a Foley catheter inserted via the appendix stump and the effluent is diverted from the proximal colon by anaesthetic scavenger tubing. The lavage is continued until the effluent is clear and anastomosis performed with one-layer interrupted absorbable sutures. There were no deaths in the series; one patient developed a wound infection and average hospitalization was 16 days (range: 6-31 days). Immediate anastomosis in selected cases of emergency distal colonic pathology is thus feasible and safe following on-table colonic lavage.

Acute Disease

Diamine oxidase activity in amniotic fluid for diagnosis of ruptured membranes.

Diamine oxidase in vaginal effluent is used as a parameter for ascertaining the state of fetal membranes. A new method using tritiated putrescine as a substrate is described for the determination of diamine oxidase in amniotic fluid and vaginal effluents. A number of tests are used for the diagnosis of premature rupture of fetal membranes. The described procedure for diamine oxidase activity determination can be used in general hospitals and has advantages over other parameters such as pH, glucose or fructose concentration, and the amniotic fluid crystallization test.

Amine Oxidase (Copper-Containing)

[Serotypes of Salmonella enterica in sewage effluent from Zaragoza. Comparison with clinical isolates. 1982-1989].

Between 1982 and 1989, 560 Salmonella enterica strains belonging to 63 serovars, were isolated from Zaragoza urban sewage. During the same period of time there were 45 different serovars isolated from faeces of patients from a hospital (in the same city). Only a reduced number of serovars comprised the majority of the human and environmental isolates. An approximately rectilinear relationship is shown between the isolated strains number and the number of different serovars, in non human Salmonella strains. In clinical isolates, we have not found this relation. We have compared the local results with those reported in other different Spanish regions.

Agglutination Tests