摘要

       抗生素、抗生素抗性细菌 (ARB)、抗生素抗性基因 (ARG) 和移动遗传元件 (MGE) 已在许多环境中被报道。然而，对它们在未经处理的医院废水中的发生情况和多样性的调查还不够。使用固相萃取和 UPLC-MS/MS 分析在医院废水中发现了高浓度的抗生素残留物。医院废水中 14 种抗生素中有 6 种的浓度达到 μg/L 水平，高于其他水生环境中报告的浓度。高通量测序分析结果表明，在我国3家医院废水中回收的可培养多重耐药菌（CMARB）中，埃希氏菌属和不动杆菌属的序列占主导地位，组成比例为34%~74%。值得注意的是，在这三家医院的废水中检测到了几个含有临床致病性或机会性 CMARB 的属（例如，埃希氏菌属、不动杆菌属、气单胞菌属、Myroides、肠球菌属、变形杆菌属、假单胞菌属和链球菌属）。高容量定量 PCR 显示在医院废水中检测到 178 个目标基因的 131-139 个独特的 ARG。 qPCR 证实了 5 个 MGEs 和 12 个 ARGs 的高流行率，并且确定了 ARGs 和 MGEs 之间的一些正相关，例如 intI1 和 qnrD、intI2 和 sul3、intI3 和 tetX、Tn916/Tn1545 和 sul2、以及 ISCR1 和 sul3 .这些结果表明，人体内已经存在高度丰富的抗生素抗性病原体和高度移动的 ARG，并且它们在未经有效治疗的情况下从医院释放会对环境和人类健康构成高风险。

       Antibiotics, antibiotic-resistant bacteria (ARB), antibiotic-resistance genes (ARGs), and mobile genetic elements (MGEs) have been reported in many environments. However, the investigation of their occurrence and diversity in untreated hospital wastewater is still insufficient. High concentrations of antibiotic residues were found in hospital wastewater using solid-phase extraction and UPLC–MS/MS analysis. The concentrations of six of 14 antibiotics reached μg/L levels in the hospital wastewater, which is higher than reported in other aquatic environments. Results of high-throughput sequencing analysis indicated that sequences affiliated to genera Escherichia and Acinetobacter were the predominant in the cultivable multiple-antibiotic-resistant bacteria (CMARB) recovered from the wastewater of three hospitals in China, with compositions of 34%–74%. Notably, several genera containing clinically pathogenic or opportunistic CMARB (e.g., Escherichia, Acinetobacter, Aeromonas, Myroides, Enterococcus, Proteus, Pseudomonas, and Streptococcus) were detected at high relative abundances in the wastewaters of the three hospitals. High-capacity quantitative PCR showed that 131–139 unique ARGs of the 178 targeted genes were detected in the hospital wastewaters. The high prevalence of five MGEs and 12 ARGs was confirmed with qPCR, and some positive correlations between ARGs and MGEs were identified, such as between intI1 and qnrD, intI2 and sul3, intI3 and tetX, Tn916/Tn1545 and sul2, and ISCR1 and sul3. These results suggest that highly abundant antibiotic-resistant pathogens and highly mobile ARGs already exist in the human body, and that their release from hospitals without effective treatment poses high risks to environments and human health.

https://www.sciencedirect.com/science/article/abs/pii/S0048969717328383