Antibiotic resistance from a WWTP perspective Picture removed from - - PDF document

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European commission, Brussels, October 2018

• D. G. Joakim Larsson, Professor in Environmental Pharmacology

Antibiotic resistance

from a WWTP perspective

Department of Infectious Diseases, Institute for Biomedicine The Sahlgrenska Academy at the University of Gothenburg, Sweden E-mail: joakim.larsson@fysiologi.gu.se Website: http://www.biomedicine.gu.se/joakimlarsson

Picture removed from presentation Please visit my website for e.g. publications, online lectures and documentaries http://www.biomedicine.gu.se/joakimlarsson

Antibiotic resistance is a fast-growing societal challenge

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The Environmental Dimensions of Antibiotic Resistance

Environment Human

• 1. Dissemination

Leonard, A.F.; Zhang, L.; Balfour, A.J.; Garside, R.; Gaze, W.H. Human recreational exposure to antibiotic resistant bacteria in coastal bathing waters. Environ Int 2015;82:92-100

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The Environmental Dimensions of Antibiotic Resistance

• 2. Emergence

70 years ago pathogens were almost always sensitive to antibiotics

Aquired resistance through mutations and uptake of resistance genes

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Antibiotic resistance in the environment is ancient

vanX bla tetM

Nature (2011) 477:457-61 Slide courtesy: Gerry Wright

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Resistance i harmless bacteria Resistance in pathogens Could be a rare or one‐time event ‐ anywhere

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Where do these critical mobilization and transfer events occur?

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Is there evidence for selection of antibiotic resistance in sewage treatment plants?

• Lots of pathogens
• High diversity of potential donors
• High bacterial density
• Presence of selective agents

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Measured concentrations of certain antibiotics in sewage treatments plants (sometimes also downstream) are often greater than Minimal Selective Concentrations

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Flach C-F, Genheden M, Larsson DGJ. 2018. A comprehensive screening of Escherichia coli from Scandinavia’s largest wastewater treatment plant shows no selection of antibiotic resistance. Environmental Science & Technology. 52:11419–11428

n=4028 isolates

…but field observations provide a less clear picture.

It is still uncertain if, where and to what degree antibiotics from domestic wastewater selects for antibiotic resistance

10/26/2018 9 Commitments on pollution control made by the worlds largest pharma companies in conjunction with the UN general assembly in New York in September 2018

• Risks for antibiotic resistance

selection has not been included in the WFD, UWWTD or EQSD

• Inclusions of certain

antibiotics on the watch list has been the result of concerns for ecological effects

• Consideration of antibiotic

resistance promotion is (at least) equally well motivated both from a PEC/PNEC standpoint and based on public/scientific concern

Report (no 770-18) soon available from The Swedish Agency for Marine and Water Management (www.havochvatten.se) or by contacting Marlene Ågerstrand at Stockholm University: Marlene.Agerstrand@aces.su.se

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Pharmaceutical production sites and surrounding environments

Photo: C. de Pedro (2006)

Larsson DGJ, de Pedro C, Paxeus N. (2007). Effluent from drug manufactures contains extremely high levels of

• pharmaceuticals. J Hazard Mater. 148:751

Larsson DGJ. (2014) Pollution from drug manufacturing: review and perspectives. Philosophical Transactions of the Royal Society B, 369: 20130571.

30 mg/L ciprofloxacin 30 ng/L ciprofloxacin

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Thank you for listening!

E-mail: joakim.larsson@fysiologi.gu.se Personal website: http://www.biomedicine.gu.se/joakimlarsson CARe website: www.care.gu.se