Impact of easing COVID-19 restrictions on antibiotic usage in Eastern China using wastewater-based epidemiology

Jinxin Zang; Lufang Jiang; Yingying Wang; Yue Chen; Chaowei Fu; Barbara Kasprzyk-Hordern; Na Wang; Qingwu Jiang; Helen Lambert

doi:10.1038/s41467-024-54498-2

Impact of easing COVID-19 restrictions on antibiotic usage in Eastern China using wastewater-based epidemiology

Jinxin Zang, Lufang Jiang, Yingying Wang, Yue Chen, Chaowei Fu, Barbara Kasprzyk-Hordern, Na Wang, Qingwu Jiang, Helen Lambert

Research output: Contribution to journal › Article › peer-review

Abstract

Coronavirus Disease 2019 (COVID-19) emerged in December 2019, prompting the implementation of a "zero-COVID" policy in Mainland China. The easing of this policy in December 2022 led to a surge in COVID cases, which was believed to significantly increase antibiotic usage, potentially due to antibiotic misuse or increased coinfections. Our study aimed to compare antibiotic consumption and patterns before and after this policy adjustment. We utilised wastewater-based epidemiology (WBE) to analyse antibiotic levels in samples collected from five wastewater treatment plants in Eastern China during January and February of 2021 and 2023. 27 antibiotics were quantified using ultra-high performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS) and analysed via WBE, with the resulting estimates compared with catchment-specific prescription data. 23 antibiotics were detected in wastewater samples, with a substantial increase in usage in 2023 (ranging from 531% to 3734%), consistent with prescription data. Here, we show a significant rise in antibiotic consumption during the COVID-19 surge and this underscores the need for further investigation into the impacts of inappropriate antibiotic use in China.

Original language	English
Article number	10161
Number of pages	1
Journal	Nature Communications
Volume	15
Issue number	1
Early online date	23 Nov 2024
DOIs	https://doi.org/10.1038/s41467-024-54498-2
Publication status	Published - 23 Nov 2024

Bibliographical note

This study received support from local Centers for Disease Control and Prevention (CDC). This work was supported by the National Nature Science Foundation of China (81861138050, C.F.) and the Medical Research Council and Newton Fund through a UK-China AMR Partnership Hub Award (MR/S013717/1, H.L.).

Data Availability Statement

All data generated in this study are provided in the article, Source data file and Supplementary Information file. The antibiotic prescribing data and wastewater data from this study are held in coded form at local Centers for Disease Control and Prevention (CDC) in study areas. While legal data sharing agreements between CDCs and theirs superior departments in charge (e.g., Health Commission or local government) prohibit CDCs from making the data publicly available. Access may be granted to those who through a request with specific data needs, analysis plans, and dissemination plans to N.W. (e-mail: [email protected]). The author will give feedback within 30 days. Source data are provided with this paper.

Acknowledgements

The authors would like to thank the managers of WWTPs for their support during the sampling period and the information provided on the wastewater characteristics.

ASJC Scopus subject areas

General Chemistry
General Biochemistry,Genetics and Molecular Biology
General Physics and Astronomy

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10.1038/s41467-024-54498-2Licence: CC BY-NC-ND

Cite this

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abstract = "Coronavirus Disease 2019 (COVID-19) emerged in December 2019, prompting the implementation of a {"}zero-COVID{"} policy in Mainland China. The easing of this policy in December 2022 led to a surge in COVID cases, which was believed to significantly increase antibiotic usage, potentially due to antibiotic misuse or increased coinfections. Our study aimed to compare antibiotic consumption and patterns before and after this policy adjustment. We utilised wastewater-based epidemiology (WBE) to analyse antibiotic levels in samples collected from five wastewater treatment plants in Eastern China during January and February of 2021 and 2023. 27 antibiotics were quantified using ultra-high performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS) and analysed via WBE, with the resulting estimates compared with catchment-specific prescription data. 23 antibiotics were detected in wastewater samples, with a substantial increase in usage in 2023 (ranging from 531% to 3734%), consistent with prescription data. Here, we show a significant rise in antibiotic consumption during the COVID-19 surge and this underscores the need for further investigation into the impacts of inappropriate antibiotic use in China.",

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Impact of easing COVID-19 restrictions on antibiotic usage in Eastern China using wastewater-based epidemiology

Abstract

Bibliographical note

Data Availability Statement

Acknowledgements

ASJC Scopus subject areas

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