Antibiotic Resistance in Septic Effluent

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Antibiotic Resistance in Septic Effluent

• 2011 National Environmental Health Association
  Meeting
• Crispin Pierce, Sasha Showsh, and Eli Gottfried
  (faculty)
• Tola Ekunsanmi, Michael Checkai, Jay Nielsen,
  Jacob Schafer, Michael Servi and Matt Haak
  (students)
• University of Wisconsin-Eau Claire

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Outline

• Background
• Antibiotic Resistance from Land Spreading?
• Antibiotic Resistance in Septic Effluent
• Big box store
• Chain restaurant
• Rehabilitation and Convalescent Center
• Surveillance and Control
• Summary of Control Measures

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Background

• Antibiotic resistance is evident when a drug can
  no longer inhibit the growth of the target
  bacteria.
• Resistance may be natural or as a result of
  mutation of existing genetic material acquiring
  new genetic material.
• Feed additives, including antibiotics, are used
  to promote growth of livestock enter the food
  chain.
• Widespread human use of antibiotics is also
  associated with antibiotic resistance.

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• According to the National Nosocomial Infections
  Surveillance (NNIS) System data on intensive care
  units (ICUs) in the U.S, 28.5 of enterococci
  associated with nosocomial infections were
  resistant to vancomycin, 31.9 of Pseudomonas
  aeruginosa were resistant to ceftazidime and 60
  of Staphylococcus aureus isolates were resistant
  to methicillin (i.e. MRSA) (1).
• More than 80 pharmaceuticals and drug
  metabolites, have been measured in µg/l-levels in
  sewage samples and downstream surface waters. (2)
• Recent research has shown certain bacteria may
  survive on a diet of the antibiotic Vancomycin.
  (3)

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• The improper disposal and overuse of antibiotics
  accelerates the spread of antibiotic-resistant
  bacteria.
• Nontherapeutic use of antibiotics in animal
  production is estimated to be the cause of about
  70 of antibiotic resistance (4).

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When food animals are treated with antibiotics to
speed growth or compensate for dirty, crowded and
stressful conditions, bacteria resistant to these
drugs proliferate and enter humans through meat
consumption. Similarly, over-prescription and
improper disposal of antibiotics lead to ground
and surface water contamination, and entry into
humans from drinking water. (Photo agmates.com)
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Transmission of antibiotic-resistant bacteria is
highest in confined populations such as
hospitalized patients, college students living in
dormitories, prison inmates, and athletes
(football players on artificial turf have 15-fold
higher prevalence rates). Populations most
likely to develop disease and death are children,
elderly, and immune-compromised individuals.
(Photo http//abopposito.blogspot.com/)
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• These bacteria in turn cause extensive disease
  and death methicillin-resistant staphylococcus
  aureus (MRSA) alone causes 1520,000 deaths in
  the United States each year (4).

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Antibiotic Resistance from Land Spreading?

• Hypothesis Agricultural fields receiving land
  spreading of septic system effluent will have
  higher levels of antibiotic resistant bacteria
  than fields without spreading.

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Materials and Methods

• Thirteen soil samples (7 control and 6 treated)
  were collected from a crop field near Eau Claire
  treated with septic system effluent (Figs. 1 and
  2). These samples were mixed with water and
  plated on Colombian Blood Agar and four
  antibiotics (chloramphenicol, tetracycline,
  erythromycin and ampicillin, Fig. 3).

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Fig. 1 Land spreading of septic tank effluent.
http//www.limemaster.com/Land_Spreading.html
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Results

• Although the fraction of antibiotic-resistant
  colonies tended to be higher for control vs.
  treated samples, this apparent difference did not
  reach a significance of plt0.05 (one-tailed
  t-test, equal variance, Fig. 4).

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Fig. 4 Colony growth and fraction of antibiotic
resistance in control and treated (septic
effluent-applied) samples for five antibiotics.
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Conclusion

• In this small study, treatment of an
  agricultural field with septic system effluent
  did not significantly change the fraction of
  bacteria that were resistant to five antibiotics
  (Kanamycin, Tetracycline, Eosine Methylene Blue,
  Erythromycin and Ampicillin).

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Antibiotic Resistance in the Effluents from a Big
Box Store, Chain Restaurant and Convalescent Home

• Bacterial antibiotic resistance generated from a
  large retail store, small chain restaurant and
  convalescent home was measured.  Several samples
  of effluent from the respective septic systems
  were analyzed for bacterial resistance to
  ampicillin, kanamycin, tetracycline, and
  erythromycin. 

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Results

• The restaurant contained higher levels of
  resistance to ampicillin, kanamycin, and
  tetracycline than the store or convalescent home,
  with an average of 51.79, 27.54, and 30.78 of
  microbial growth resistant to the respective
  antibiotics. 

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• Erythromycin resistance was highest in effluent
  discharged from the convalescent home at 22
  compared to the store at 7.00 and restaurant at
  2.87.

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Conclusion

• Our research analyzed wastewater effluent from a
  rehabilitation and convalescent facility, a
  big-box store, a local chain restaurant, and
  septic sewage spread agricultural and untreated
  soils. We found that wastewater and soil samples
  contained fractions of antibiotic resistant
  bacteria from 0.552.

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Surveillance and Control

• Wisconsin State Division of Health
• Information for Health Care Providers
• Antibiotic Resistance Report

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Summary of Control Measures

• Surveillance of hospital and non-hospital
  incidence and prevalence.
• Appropriate use of antibiotics
• Use only when needed
• Proper disposal
• Legislation to limit non-therapeutic use in
  animals.
• Sanitation

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References

• 1. Wisconsin Division of Public Health Bureau of
  Communicable Diseases and Preparedness Guidelines
  for Prevention and Control of Antibiotic
  Resistant Organisms in Health Care Settings,
  September, 2005.
• 2. Herberer, Thomas. "Toxicology Letters
  Occurrence, Fate, and Removal of Pharmaceutical
  Residues in the Aquatic Environment a Review of
  Recent Research Data." ScienceDirect. 15 Mar.
  2002. Toxicology Letters. 7 Apr. 2008
• 3. "Antibiotic-eating germ alarms doctors -
  Enterococcus faecium bacterium survives on diet
  of the antibiotic vancomycin - Biomedicine -
  Brief Article". Science News. Dec 21, 1996.
• 4. Pew Charitable Trusts. Human Health and
  Antibiotic use in Industrial Farming 2010.
• Additional References
• Paterson, David . "Update on Antibiotic
  Resistance in Hospitals." The Prevalence of
  Antibiotic Resistance in the Hospital Setting.
  2006. 20 Apr 2007 lthttp//www.medscape.com/editori
  al/cmetogo/5541gt.
• Fridkin, Scott K. et al. "Temporal Changes in
  Prevalence of Antimicrobial Resistance in 23 U.S.
  Hospitals." Emerging Infectious Diseases Vol. 8,
  No. 7,(2002) 697-701.
• Lipsitch, Marc. "The epidemiology of antibiotic
  resistance in hospitalsParadoxes and
  prescriptions." PNAS vol.97(2000) 1938-1943.

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Thanks for Your Attention
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Contact Information

• Crispin H. Pierce, Ph.D.
• Associate Professor / Program Director
• Department of Public Health Professions
• 244 Nursing
• University of Wisconsin - Eau Claire
• Eau Claire, WI 54702-4004
• [phone]
• http//www.uwec.edu/piercech
• http//www.uwec.edu/ph/enph/