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Antibiotics, toxic metals and multiresistant bacteria in hospital and urban sewage and their potential impact on receiving water ecosystems

Grant number: 19/05938-3
Support Opportunities:Scholarships in Brazil - Doctorate
Effective date (Start): September 01, 2020
Effective date (End): December 31, 2022
Field of knowledge:Health Sciences - Nursing - Public Health Nursing
Principal Investigator:Susana Segura Muñoz
Grantee:Guilherme Sgobbi Zagui
Host Institution: Escola de Enfermagem de Ribeirão Preto (EERP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil


Hospital and urban sewage are considered as matrices that pose risks to human and environmental health due to the microbiological composition of pathogens and chemical substances. Among the chemical pollutants are antibiotics and toxic metals because they are considered pollutants of the environment and selectors of multiresistant bacteria due to their antibacterial characteristics. Therefore, hospital and WWTP sewages are considered reservoirs of resistant microorganisms, favoring the exchange of genetic elements of resistance, as well as facilitating their environmental dissemination. In these matrices, clinically important bacteria bearing antibiotic resistance genes was identified, representing a risk due to the limited therapeutic options available. Some metals such as Ag, As, Cd, Cu, Hg, Te, and Zn have antibacterial properties and interest as antimicrobials has been reemerging with increasing bacterial resistance to antibiotics around the world. However, mechanisms of resistance to these metals are already being described mainly in coexistence with antibiotic resistance genes, but their epidemiological distribution is not known. Such pollutants can adversely impact receiving water ecosystems and pose risks to users if they are not removed at sewage treatment plants. In this sense, the objectives of the present study are to quantify antibiotics and toxic metals and to verify the occurrence of multiresistant bacteria (carriers of resistance genes) in hospital sewage, in urban raw and treated sewage and in rivers and to evaluate the possible impacts on the water ecosystems receptors and the risks to the adjacent population. In the tertiary hospital, samples will be collected from three sewage inspection boxes that intercept effluents from outpatient clinics, infirmaries and the confluence of all hospital effluents. At the treatment plant, samples will be collected in the inlet (raw sewage) and after the secondary settler (treated sewage), prior to launching into the stream. The dosages of cefotaxime, ceftazidime, imipenem, meropenem, ciprofloxacin, gentamicin, sulfamethoxazole and tetracycline will be determined by HPLC and the toxic metals Ag, As, Cd, Cu, Hg, Te and Zn by ICP-MS. The bacterial identification will be through isolation in selective culture media and biochemical kits. The antibiotic sensitivity test will be performed by disc-diffusion in agar and the disc tests combined with clavulanic acid and Blue Carba will be used to identify bacteria producing spectral-extended ²-lactamases and carbapenemases, respectively. Genes from antibiotic hydrolyzing enzymes as well as resistance to toxic metals will be screened for PCR and sequencing. Next, the transferability of mobile genetic elements of resistance through conjugation experiments will be evaluated. The data will be evaluated in statistical programs and according to the evidence will be made a reflection on the possible impacts on the water ecosystems receiving effluents with the chemical and microbiological pollutants studied. (AU)

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Scientific publications (4)
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
ZAGUI, GUILHERME SGOBBI; MOREIRA, NATALIA COLUMBARO; SANTOS, DANILO VITORINO; PASCHOALATO, CRISTINA FILOMENA PEREIRA ROSA; SIERRA, JORDI; NADAL, MARTI; DOMINGO, JOSE L.; DARINI, ANA LUCIA COSTA; ANDRADE, LEONARDO NEVES; SEGURA-MUNOZ, SUSANA INES. Multidrug-resistant Enterobacter spp. in wastewater and surface water: Molecular characterization of β-lactam resistance and metal tolerance genes. Environmental Research, v. 233, p. 7-pg., . (19/18663-2, 19/05938-3)
ZAGUI, GUILHERME SGOBBI; MOREIRA, NATALIA COLUMBARO; SANTOS, DANILO VITORINO; DARINI, ANA LUCIA COSTA; DOMINGO, JOSE L.; SEGURA-MUNOZ, SUSANA INES; ANDRADE, LEONARDO NEVES. High occurrence of heavy metal tolerance genes in bacteria isolated from wastewater: A new concern?. Environmental Research, v. 196, . (19/05938-3, 19/18663-2)
ZAGUI, GUILHERME SGOBBI; ALMEIDA, OTAVIO GUIHERME GONCALVES DE; MOREIRA, NATALIA COLUMBARO; ABICHALKI, NATHALIA; MACHADO, GABRIEL PINHEIRO; MARTINIS, ELAINE CRISTINA PEREIRA DE; DARINI, ANA LUCIA COSTA; ANDRADE, LEONARDO NEVES; SEGURA-MUNOZ, SUSANA INES. A set of antibiotic-resistance mechanisms and virulence factors in GES-16-producing Klebsiella quasipneumoniae subsp. similipneumoniae from hospital wastewater revealed by whole-genome sequencing. Environmental Pollution, v. 316, p. 8-pg., . (18/13564-3, 19/18663-2, 19/05938-3)
ZAGUI, GUILHERME SGOBBI; ANDRADE, LEONARDO NEVES; SIERRA, JORDI; ROVIRA, JOAQUIM; DARINI, ANA LUCIA COSTA; SEGURA-MUNOZ, SUSANA. Plastisphere as a pathway for antimicrobial-resistant bacteria spread to the environment: New challenge and open questions. Environmental Research, v. 214, p. 3-pg., . (19/18663-2, 19/05938-3)
Academic Publications
(References retrieved automatically from State of São Paulo Research Institutions)
ZAGUI, Guilherme Sgobbi. Antibiotics and multidrug-resistant bacteria in sewage and receiving surface waters: risks of spreading genes encoding ESBL, carbapenemases and metal tolerance in the context of one health. 2022. Doctoral Thesis - Universidade de São Paulo (USP). Escola de Enfermagem de Ribeirão Preto (PCARP/BC) Ribeirão Preto.

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