Quantifying community-wide antimicrobials usage via wastewater-based epidemiology

Elizabeth Holton, Natalie Sims, Kishore Kumar Jagadeesan, Richard Standerwick, Barbara Kasprzyk-Hordern

Research output: Contribution to journalArticlepeer-review

17 Citations (SciVal)

Abstract

Increasing usage of antimicrobials is a significant contributor to the emergence and dissemination of antimicrobial resistance. Wastewater-based epidemiology is a useful tool for evaluating public health, via the monitoring of chemical and biological markers in wastewater influent, such as antibiotics. Sixteen antimicrobials and their metabolites were studied: sulfonamides, trimethoprim, metronidazole, quinolones, nitrofurantoin, cyclines, and antiretrovirals. Correction factors (CFs) for human drug excretion, for various drug forms, were determined via a systematic literature review of pharmacokinetic research. Analyte stability was examined over a 24 h study. The estimation of community-wide drug intake was evaluated using the corresponding catchment prescription data. Overall, antimicrobials excreted in an unchanged form were often observed to over-estimate daily intake. This could be attributed to biotransformation, e.g., via glucuronide cleavage, or direct disposal of unused drugs. Acetyl-sulfonamides, trimethoprim, hydroxy-metronidazole, clarithromycin, ciprofloxacin, ofloxacin, tetracycline, and oxytetracycline generally performed well in the estimation of drug intake, relative to prescription records. The low prevalence of quinolone and trimethoprim metabolites, and the low stability of nitrofurantoin, limited the ability to evaluate these metabolites and their respective CFs.
Original languageEnglish
Article number129001
JournalJournal of Hazardous Materials
Volume436
Early online date26 Apr 2022
DOIs
Publication statusPublished - 15 Aug 2022

Bibliographical note

Funding Information:
Elizabeth Holton would like to acknowledge University of Bath for funding her Ph.D. The support of Engineering and Physical Sciences Research Council (EP/P028403/1) is greatly appreciated. The support of Wessex Water Services Ltd and EPSRC Impact Acceleration Account (Project number: EP/R51164X/1, ENTRUST IAA) is greatly appreciated. Antimicrobial resistance (AMR) is a consequence of extensive antimicrobials (AAs) use. Unfortunately, there is little understanding of spatiotemporal AAs usage due to lack of robust surveillance and environment monitoring frameworks. Wastewater-Based Epidemiology (WBE) offers an attractive solution as it can provide evidence of public use of AAs at high spatial and temporal resolution. It can also assess environmental impacts. This manuscript presents a new WBE workflow via: (1) Establishment of a robust metabolic transformation Correction Factors utilising systematic literature review workflows (2) Model calibration using per postcode AA prescription model (3) Estimation of antimicrobial intake in an intercity study.

Funding Information:
Elizabeth Holton would like to acknowledge University of Bath for funding her Ph.D. The support of Engineering and Physical Sciences Research Council ( EP/P028403/1 ) is greatly appreciated. The support of Wessex Water Services Ltd and EPSRC Impact Acceleration Account (Project number: EP/R51164X/1 , ENTRUST IAA ) is greatly appreciated.

Keywords

  • Antibiotic
  • Excretion
  • Metabolism
  • Prescription

ASJC Scopus subject areas

  • Environmental Engineering
  • Environmental Chemistry
  • Waste Management and Disposal
  • Pollution
  • Health, Toxicology and Mutagenesis

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