摘要

医院废水是一种高度复杂的废水，是抗生素耐药菌的研究热点。尤其是在医院废水中，越来越多的革兰氏阴性菌具有多重耐药基因。本研究旨在评估一家斯洛文尼亚医院和两家奥地利医院的医院废水中是否存在产ESBL和碳青霉烯酶的肠杆菌科细菌，以及医院废水中是否存在VIM、KPC、NDM、CTXM和OXAβ-内酰胺酶的耐药基因。结果表明，产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌含量高达107cfu/mL，产碳青霉烯酶的肠杆菌科细菌和OXA 48型CPE的含量高达105cfu/mL。在89个多重PCR扩增子中，只有36个对不同的β-内酰胺酶基因家族呈阳性，这其中只有三个分离株具有多重耐药性。19个分离株的ESBL家族以CTXM为主。接着是10个OXA-48阳性菌株和10个VIM阳性菌株。对分离株的PCR检测未发现KPC或NDM碳青霉烯酶。医院废水几乎是所有临床上重要的抗生素耐药性的蓄水池。当暴发病例不能与流行病学来源联系起来时，评估这种潜在环境水库的重要性尤其明显。

Hospital wastewaters are highly complex effluents acting as a hotspot for antibiotic resistant bacteria. Especially, Gram-negative bacteria bearing multiple antibiotic resistant genes are increasingly found in hospital wastewaters. The aim of this study was to evaluate the presence of ESBL and Carbapenemase producing Enterobacteriaceae in hospital wastewaters from one Slovenian and two Austrian hospitals, as well as the occurrence of antibiotic resistant genes encoding for VIM, KPC, NDM, CTXM and OXA beta-lactamases in isolates from hospital wastewater. The results indicated high levels of extended-spectrum beta-lactamases (ESBL) producing Enterobacteriaceae in ranges up to 10⁷ cfu/mL. Carbapenemase producing Enterobacteriaceae and OXA 48-type CPE were present in ranges up to 10⁵ cfu/mL. Out of 89 multiplied PCR amplicons, only 36 were positive for different β-lactamase gene families, among those only three isolates were identified as multiresistant. The dominant ESBL family was CTXM in 19 different isolates. This was followed by 10 OXA-48 positive isolates and 10 VIM positive isolates. KPC or NDM carbapenemases were not identified with PCR screening of the isolates. Hospital wastewaters serve as a reservoir for nearly all clinically important antibiotic resistances. The importance of evaluating such potential environmental reservoirs is especially evident when outbreak cases could not be linked to an epidemiological source.

https://iwaponline.com/washdev/article-abstract/doi/10.2166/washdev.2020.086/72307/Hospital-wastewater-effluent-hot-spot-for