Perfil de resistência aos antibióticos e prevalência dos genes qacEΔ1 e sul1 em Pseudomonas aeruginosa de efluente hospitalar / Antibiotic resistance pattern and prevalence of qacEΔ1 and sul1 genes in Pseudomonas aeruginosa from hospital wastewater

Introdução: Efluentes hospitalares representam riscos à saúde pública e ambiental devido à presença de microrganismos patogênicos, drogas e produtos químicos. Pseudomonas aeruginosa é um patógeno oportunista frequentemente encontrado no ambiente hospitalar. Objetivo: Avaliar o resistoma de isolados de P. aeruginosa da estação de tratamento de esgoto hospitalar (ETEH) de um complexo hospitalar na cidade do Rio de Janeiro. Método: Vinte isolados dos cinco estágios da ETEH foram identificados como P. aeruginosa pelo sequenciamento do gene 16S rRNA. A suscetibilidade aos antibióticos foi determinada segundo o CLSI e os genes qacEΔ1 e sul1 foram detectados pela PCR. Resíduos de sulfonamidas foram pesquisados por cromatografia líquida de alta eficiência acoplada à espectrometria de massas sequencial. Resultados: Foi demonstrada a presença de sulfametoxazol em nível inferior a 50 ng∙L−1, resistência às sulfonamidas (80%) seguida pelas quinolonas (50%) e 13 perfis de suscetibilidade aos antimicrobianos. Os genes qacEΔ1-sul1 foram detectados em 100% dos isolados, sugerindo a presença de integrons de classe 1 em toda a ETEH. Conclusões: Os resultados sinalizaram limitações no tratamento e a propagação de genes de resistência nas etapas da ETEH. Esses dados contribuem com órgãos competentes no desenho de ações preventivas frente aos impactos negativos à saúde pública.

Introduction: Hospital effluents may pose great environmental risk due to the presence of pathogenic microorganisms, drugs and chemical components. Pseudomonas aeruginosa is an opportunistic pathogen frequently found in hospital environment. Objective: To evaluate the resistome of P. aeruginosa from the hospital wastewater treatment plant (HWTP) in a hospital complex of Rio de Janeiro city. Method: Twenty isolates from the five stages of the HWTP were identified as P. aeruginosa by 16S rRNA gene sequencing analysis. Susceptibility to antibiotics was determined according to CLSI and qacEΔ1 and sul1 genes were detected by PCR. Sulphonamide residues were investigated by high performance liquid chromatography coupled to sequential mass spectrometry. Results: The sulfamethoxazole has been demonstrated at a level below 50 ng L-1. Sulfonamide resistance (80%) has been demonstrated followed by quinolone class (50%) and 13 susceptibility patterns to antimicrobials. The qacEΔ1-sul1 genes were detected in 100% of isolates suggesting the presence of class 1 integrons in the whole HWTP. Conclusions: The results signalized limitations of HWTP and propagation of resistance genes in all stages of the HWTP. These data also contribute to the environmental sanitary surveillance in the design of prevention actions against negative impact on the public health.

Surveillance and drug resistance analysis of thermotolerant Escherichia coli in sewage from hospitals in Shaoxing / 中华医院管理杂志

Objective To analyze the drug resistance and detect the drug resistance genes of pathogenic bacteria isolated from hospital sewage , and to investigate the sources of antibiotic resistant microorganisms in the environment .Methods The enteric pathogenic bacteria , such as thermotolerant Escherichia coli , Salmonella and Shigella , were isolated from the sewage of Shaoxing hospitals from January 2016 to December 2016 , and the detection of drug resistance of thermotolerant Escherichia coli , the drug resistance of Escherichia coli isolated from clinical specimens of three hospitals was compared and analyzed . Meanwhile , extended spectrum beta lactamases ( ESBLs ) resistance genes were detected in thermotolerant Escherichiacoliinsewage.Results 48strainsofpathogenswereisolatedinsewage,including32strainsof Escherichia coli , 2 strains of Shigella sonnei and 1 strain of Salmonella arizonae .Escherichia coli has a low rate of resistance to most antibiotics .Compared to Escherichia coli isolated from clinical specimens , there were significant differences among the drug resistance rates of Ampicillin , Aztreonam, Amoxicillin/Clavulanic acid and the first to four generation Cephalosporins (P<0.05).11 strains of ESBLs positive bacteria were detected in sewage .Among them , 7 carried CTX-M9 resistance genes , and 4 carried TEM resistance genes , while 1 strain of CTX-M1 and SHV was carried .There were 2 strains carrying CTX-M9 and TEM resistance genes simultaneously , 1 strain simultaneously carrying TEM and SHV resistance genes . Conclusions There are different kinds of intestinal pathogens in hospital sewage , which may lead to contamination of drug-resistant microorganisms in the environment .Therefore the hospitals should strengthen the quality of sewage treatment and improve the qualified rate of sewage disinfection .

SUBACUTE ORAL TOXICITY STUDIES OF BCDMH EFFERVESCENT TABLETS FOR HOS-PITAL SEWAGE / 现代医院

Objective To study subacute oral toxicity of a disinfectant for hospital sewage which contained 1-bromo -3 -chloro -5, 5 -dimethylhydantoin (BCDMH) in order to know about its toxicological safety .Methods Animal test and biochemical examination methods were adopted to evaluate its subacute toxicity .Results During the subacute toxicity test, none of the rats died.At the end of the experiment , urine routine and hematological exami -nation were in the normal ranges .There were no difference compared with the control (p >0.05).But serum alanine aminotransferase in both sexes as well as creatinine in male SD rats of the high dose group were increased obviously compared with the control (p <0.05).Mild steatosis and spotty necrosis of liver cells were found in the high dose group during the pathological examination .Conclusion The BCDMH effervescent tablets'no -observed -adverse -effect -level (NOAEL) is 84 mg? kg-1 for male SD rats, and 98 mg? kg-1 for female SD rats.

Identificação de compostos orgânicos e farmacêuticos em esgoto hospitalar utilizando cromatografia gasosa acoplada a espectrometria de massa / Identification of organic and pharmaceutical compositions in hospital wastewater using a gas chromatograph coupled to mass spectrometry

Os resíduos líquidos provenientes dos estabelecimentos assistenciais de saúde são mais complexos do que os esgotos domésticos. Sua composição contém inúmeros compostos farmacêuticos, saneantes, elementos radiativos e de laboratórios. O conhecimento desses compostos pode auxiliar na escolha do tratamento adequado para esses esgotos e diminuir os impactos ambientais nos corpos receptores. A pesquisa foi realizada utilizando um sistema combinado (UASB e lodos ativados) para tratar a água residuária de um hospital. Neste trabalho, foram realizadas análises físico-químicas para caracterização do esgoto e cromatografia gasosa acoplada à espectrometria de massa para identificação de compostos químicos farmacêuticos, podendo-se constatar a presença de inúmeros elementos residuais dos fármacos usados no hospital.

Liquid waste residues from health care establishments are more complex than those from residential sewage. Their composition contains several pharmaceutical chemical composites, sanitizers, radioactive, and laboratorial elements. Knowing about these composites may aid in choosing the proper treatment for these sewages, and diminish the environmental impact in receptors. The study was carried out in a combined system (UASB and activated sludge) to treat a hospital wastewater. In this experiment, material and chemical analyses were employed to trace sewage characteristics and gas chromatography associated with mass spectrometry to identify pharmacologic chemical composites, where innumerous residual elements were found in chromatographs.

Resistência a β-lactâmicos em Acinetobacter spp isolados de efluente hospitalar no sul do Brasil / Resistance to β-lactams among Acinetobacter spp isolated from hospital sewage in southern Brazil

Acinetobacter spp é um importante patógeno causador de infecções nosocomiais que acomete pacientes imunocomprometidos e capaz de adquirir resistência a antimicrobianos com facilidade. Os esgotos hospitalares são importantes disseminadores de genes de resistência a antimicrobianos para a microbiota ambiental. Neste contexto, 30 cepas de Acinetobacter spp provenientes de efluente de um hospital em Porto Alegre, RS, foram analisados quanto ao perfil de susceptibilidade a β-lactamases, quinolonas e aminoglicosídeos através de antibiograma e testes de triagem para metalo beta-lactamases e β-lactamases de espectro estendido. O perfil encontrado revela cepas multi-resistentes e que mecanismos de resistência como a produção de β-lactamases de espectro estendido e bombas de efluxo podem estar presentes nesses isolados.

Acinetobacter spp is an important pathogen that is responsible for nosocomial infections affecting immunocompromised patients, and it can easily acquire resistance to antimicrobial agents. Hospital sewage is an important means for disseminating genes for resistance to antimicrobial agents, to the microbiota of the environment. Within this context, 30 strains of Acinetobacter spp from the sewage of a hospital in Porto Alegre, Rio Grande do Sul, were analyzed regarding their profile of susceptibility to β-lactams, quinolones and aminoglycosides, by means of an antibiogram and tests to screen for metallo-β-lactamases and extended-spectrum β-lactamases. The profile obtained revealed the presence of multidrug-resistant strains and showed that resistance mechanisms such as the production of extended-spectrum β-lactamases and efflux pumps may be present in these strains.

Disseminação de Metalo-ß-Lactamases: triagem revela a presença do gene BLA SPM-1 em efluente hospitalar no Sul do Brasil / Spread of Metalo-ß-Lactamases: screening reveals the presence of a BLA SPM-1 gene in hospital sewage in southern Brazil

Of 396 Pseudomonas aeruginosa strains isolated from hospital sewage, the blaSPM-1 gene was confirmed in nine. This is the first report of environmental P. aeruginosa strains carrying the blaSPM-1 gene in Brazil. The carbapenem resistance, already disseminated among clinical isolates, has been detected among environmental isolates.

Ao todo, 396 isolados de Pseudomonas aeruginosa foram estudados. O gene blaSPM-1 foi encontrado em nove isolados de efluente hospitalar. Este estudo é o primeiro relato de isolados ambientais de P. aeruginosa com o gene blaSPM-1no Brasil. A resistência aos carbapenêmicos, amplamente disseminada entre isolados clínicos, já é detectada em isolados ambientais.

Pseudomonas aeruginosa: disseminação de resistência antimicrobiana em efluente hospitalar e água superficial / Pseudomonas aeruginosa: spread of antimicrobial resistance in hospital effluent and surface water

O objetivo deste estudo foi comparar amostras de efluente do Hospital São Vicente de Paulo com amostras de água do Rio Passo Fundo, quanto ao perfil de susceptibilidade de isolados de Pseudomonas aeruginosa, para inferir sobre a presença de isolados de origem hospitalar em amostras de água superficial. A significância estatística entre os perfis de susceptibilidade das amostras foi testada por análise de variância e a comparação das amostras foi feita por contrastes de interesse. Foram identificados 198 isolados de Pseudomonas aeruginosa a partir das amostras analisadas. O fenótipo de multirresistência não foi observado nas amostras do Rio Passo Fundo, embora alguns isolados resistentes a carbapenêmicos tenham sido identificados, indicando a presença de contaminação com bactérias provenientes de um ambiente sob forte pressão seletiva. Diferenças significativas entre as amostras de água e efluente hospitalar foram observadas a partir da análise de variância por contrastes de interesse.

The aim of this study was to compare sewage samples from Hospital São Vicente de Paulo with water samples from the Passo Fundo river, with regard to the susceptibility profile of Pseudomonas aeruginosa isolates, in order to make inferences about the presence of strains of hospital origin in surface water samples. The statistical significance between the susceptibility profiles of the samples was tested using analysis of variance, and the samples were compared by means of contrasts of interest. One hundred and ninety-eight isolates of Pseudomonas aeruginosa were recovered from the samples analyzed. No phenotype for multiresistance was found in the samples from the Passo Fundo river, although some carbapenem-resistant isolates were identified, thereby indicating the presence of contamination with bacteria derived from an environment under strong selection pressure. Significant differences between the water and hospital effluent samples were observed, based on the analysis of variance by means of contrasts of interest.