Antimicrobial resistant Escherichia coli in the municipal wastewater system: effect of hospital effluent and environmental fate.

The prevalence of antimicrobial resistant (AMR) bacteria is increasing worldwide and remains a significant medical challenge which may lead to antimicrobial redundancy. The contribution of hospital effluent to the prevalence of resistance in wastewater treatment plant (WWTP) effluents is not fully understood. AMR bacteria contained in hospital effluent may be released into the aquatic and soil environments after WWTP processing. Hence, the objective of this study is to identify the extent hospital effluent contributes to contamination of these environments by comparing two WWTPs, one which receives hospital effluent and one which does not. AMR Escherichia coli were monitored in the two WWTPs. A model was developed using these monitored values to predict the effect of hospital effluent within a WWTP. The model predicted levels of AMR E. coli in the aquatic environment and potential bather exposure to AMR E. coli. The model results were highly variable. WWTP influent containing hospital effluent had a higher mean percentage of AMR E. coli; although, there appeared to be no within treatment plant effect on the prevalence of AMR E. coli. Examination of WWTP sludge showed a similar variation. There appeared to be no consistent effect from the presence of hospital effluent. The human exposure assessment model predicted swimmer intake of AMR E. coli between 6 and 193CFU/100ml sea water. It appears that hospital effluent is not the main contributing factor behind the development and persistence of AMR E. coli within WWTPs, although resistance may be too well-developed to identify an influence from hospital effluent. Mitigation needs to focus on the removal of already present resistant bacteria but for new or hospital specific antimicrobials focus needs to be on their limited release within effluents or separate treatment.