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

10/26/2018 Antibiotic resistance from a WWTP perspective Picture removed from presentation Please visit my website for e.g. publications, online lectures and documentaries http://www.biomedicine.gu.se/joakimlarsson European commission, Brussels, October 2018 D. G. Joakim Larsson, Professor in Environmental Pharmacology 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 Antibiotic resistance is a fast-growing societal challenge 1

10/26/2018 The Environmental Dimensions of Antibiotic Resistance 1. Dissemination Human Environment 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 2

10/26/2018 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 3

10/26/2018 Antibiotic resistance in the environment is ancient vanX bla tetM Picture removed from presentation Nature (2011) 477 :457-61 Slide courtesy: Gerry Wright Resistance i harmless bacteria Resistance in pathogens Could be a rare or one ‐ time event ‐ anywhere 4

10/26/2018 Where do these critical mobilization and transfer events occur? 5

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10/26/2018 Is there evidence for selection of antibiotic resistance in sewage treatment plants? Picture removed from presentation • Lots of pathogens • High diversity of potential donors • High bacterial density • Presence of selective agents Measured concentrations of certain antibiotics in sewage treatments plants (sometimes also downstream) are often greater than Minimal Selective Concentrations 7

10/26/2018 …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 n=4028 isolates 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 8

10/26/2018 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 9

10/26/2018 Pharmaceutical production sites and surrounding environments 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. Photo: C. de Pedro (2006) 30 mg/L ciprofloxacin 30 ng/L ciprofloxacin 10

10/26/2018 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 11