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The association between antibiotic use in hospitals and residual antibiotic concentrations in hospital effluents: a pilot study

Year: 2025

Type: article

Abstract: Objective To analyse the possible association between hospital antibiotic use and residual antibiotic concentrations in wastewater effluents, with the aim of evaluating wastewater surveillance as a potential alternative antimicrobial use monitoring system (AlAUMS). Methods The study was conducted at a Regional Hospital in South Africa and followed an observational, quantitative and correlational design. The hospital use of selected antibiotics was determined using consumption data as a proxy and calculated using the WHO Anatomic Therapeutic Chemical (ATC) and DDD methodology. Selected antibiotics in the hospital effluent were analysed by solid-phase extraction (SPE) and quantified by GC–MS. Spearman’s rank correlation coefficient and P values were calculated to determine the possible association between antibiotic use and residual antibiotic concentrations as an AlAUMS. Findings The highest mean antibiotic use in the hospital was for oral sulfamethoxazole (6.71 DDD/100 bed days), followed by parenteral cefazolin (3.15 DDD/100 bed days). The highest mean antibiotic concentration in the hospital effluent was for sulfamethoxazole (34.57 μg/L) followed by cefazolin (25.32 μg/L). A strong positive correlation was observed for sulfamethoxazole (Rs = 0.86) and a moderate positive correlation for cefazolin (Rs = 0.50). However, none were statistically significant. Conclusions The positive correlation displayed between the use of cefazolin and sulfamethoxazole and their concentrations in wastewater indicates a potential association between antibiotic use and residual antibiotic concentrations in hospital settings suggesting that wastewater surveillance is a promising proxy for conventional antibiotic use surveillance. Further studies are necessary to validate these results before wastewater surveillance can be implemented as an AlAUMS.

Source: JAC-Antimicrobial Resistance

DOI: 10.1093/jacamr/dlaf070

Authors: Fatima Zahra Deedat, Andile Mbuso Faya, Bhekumuzi Prince Gumbi, Deanne Mary Graham Johnston, Rajshekhar Karpoormath, Sabiha Yusuf Essack

Institution: University of KwaZulu-Natal

Language: English

Topic: Pharmaceutical and Antibiotic Environmental Impacts

Subfield: Pollution

Field: Environmental Science

Domain: Physical Sciences

SDGs: Good health and well-being, Clean water and sanitation

Open Access status: gold

Estimated APC paid: $2,609