Assessment of community-wide antimicrobials usage in Eastern China using wastewater-based epidemiology

Like Xu; Jinxin Zang; Wenjuan Cong; Elizabeth Holton; Samuel Sheppard; Yingying Wang; Na Wang; Jason  Weeks; Chaowei Fu; Qingwu Jiang; Helen S Lambert; Barbara Kasprzyk-Hordern

doi:10.1016/j.watres.2022.118942

Assessment of community-wide antimicrobials usage in Eastern China using wastewater-based epidemiology

Like Xu
, Jinxin Zang
, Wenjuan Cong
, Elizabeth Holton
, Samuel Sheppard
, Yingying Wang
, Na Wang^*
, Jason Weeks
, Chaowei Fu
, Qingwu Jiang
, Helen S Lambert
, Barbara Kasprzyk-Hordern^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

Highlights

•First application of WBE in Eastern China to assess the community-wide antimicrobials usage.

•Spatiotemporal trends in concentrations, daily loads and population-normalised daily loads were measured.

•Paired parent and metabolite analysis were included.

•Contribution of environmental AMR from antibiotic manufacturing was recognised.

Abstract

Wastewater-based epidemiology (WBE) has potential to identify the epidemiological links between people, animals, and the environment, as part of antimicrobial resistance (AMR) surveillance. In this study, we investigated six wastewater treatment plants (WWTPs) serving six communities located in two regions in Eastern China: Site A in Zhejiang and site B in Jiangsu province to assess the public use of antimicrobial agents (AA). Fifty antimicrobials and 24 of their metabolites were quantified using ultraperformance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS). Spatiotemporal trends were established for measured concentrations, daily loads, and population-normalised daily loads. Daily AA mass loads varied between 1.6 g/day and 324.6 g/day reflecting the WWTP scales, with macrolides and β-lactams showing the highest overall environmental burden at 223.7 g/day and 173.7 g/day, respectively. Emissions of antibiotic residues from manufacturing have been observed, with the peak daily load 12-fold higher than the overall load from a community serving a population of over 600,000. Community exposure levels of 225.2 ± 156.2 mg/day/1000 inhabitant and 351.9 ± 133.5 mg/day/1000 inhabitant were recorded in site A and B, respectively. Paired parent-metabolites analysis identified a large proportion (64–78%) of un-metabolised metronidazole and clindamycin at site B, indicating improper disposal of unused drugs either in the community or in livestock production. Consumption levels, calculated via WBE, suggested relatively low antimicrobial usage in Eastern China compared to other areas in China. This first application of WBE in Eastern China to assess the community-wide exposure to AAs has potential to inform regional antimicrobial stewardship.

Original language	English
Article number	118942
Number of pages	14
Journal	Water Research
Volume	222
Early online date	2 Aug 2022
DOIs	https://doi.org/10.1016/j.watres.2022.118942
Publication status	Published - 15 Aug 2022

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@article{9c85e22b0ac948259e0a37e217dd3c3a,

title = "Assessment of community-wide antimicrobials usage in Eastern China using wastewater-based epidemiology",

abstract = "Highlights •First application of WBE in Eastern China to assess the community-wide antimicrobials usage. •Spatiotemporal trends in concentrations, daily loads and population-normalised daily loads were measured. •Paired parent and metabolite analysis were included. •Contribution of environmental AMR from antibiotic manufacturing was recognised. Abstract Wastewater-based epidemiology (WBE) has potential to identify the epidemiological links between people, animals, and the environment, as part of antimicrobial resistance (AMR) surveillance. In this study, we investigated six wastewater treatment plants (WWTPs) serving six communities located in two regions in Eastern China: Site A in Zhejiang and site B in Jiangsu province to assess the public use of antimicrobial agents (AA). Fifty antimicrobials and 24 of their metabolites were quantified using ultraperformance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS). Spatiotemporal trends were established for measured concentrations, daily loads, and population-normalised daily loads. Daily AA mass loads varied between 1.6 g/day and 324.6 g/day reflecting the WWTP scales, with macrolides and β-lactams showing the highest overall environmental burden at 223.7 g/day and 173.7 g/day, respectively. Emissions of antibiotic residues from manufacturing have been observed, with the peak daily load 12-fold higher than the overall load from a community serving a population of over 600,000. Community exposure levels of 225.2 ± 156.2 mg/day/1000 inhabitant and 351.9 ± 133.5 mg/day/1000 inhabitant were recorded in site A and B, respectively. Paired parent-metabolites analysis identified a large proportion (64–78\%) of un-metabolised metronidazole and clindamycin at site B, indicating improper disposal of unused drugs either in the community or in livestock production. Consumption levels, calculated via WBE, suggested relatively low antimicrobial usage in Eastern China compared to other areas in China. This first application of WBE in Eastern China to assess the community-wide exposure to AAs has potential to inform regional antimicrobial stewardship.",

author = "Like Xu and Jinxin Zang and Wenjuan Cong and Elizabeth Holton and Samuel Sheppard and Yingying Wang and Na Wang and Jason Weeks and Chaowei Fu and Qingwu Jiang and Lambert, \{Helen S\} and Barbara Kasprzyk-Hordern",

year = "2022",

month = aug,

day = "15",

doi = "10.1016/j.watres.2022.118942",

language = "English",

volume = "222",

journal = "Water Research",

issn = "0043-1354",

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}

TY - JOUR

T1 - Assessment of community-wide antimicrobials usage in Eastern China using wastewater-based epidemiology

AU - Xu, Like

AU - Zang, Jinxin

AU - Cong, Wenjuan

AU - Holton, Elizabeth

AU - Sheppard, Samuel

AU - Wang, Yingying

AU - Wang, Na

AU - Weeks, Jason

AU - Fu, Chaowei

AU - Jiang, Qingwu

AU - Lambert, Helen S

AU - Kasprzyk-Hordern, Barbara

PY - 2022/8/15

Y1 - 2022/8/15

N2 - Highlights •First application of WBE in Eastern China to assess the community-wide antimicrobials usage. •Spatiotemporal trends in concentrations, daily loads and population-normalised daily loads were measured. •Paired parent and metabolite analysis were included. •Contribution of environmental AMR from antibiotic manufacturing was recognised. Abstract Wastewater-based epidemiology (WBE) has potential to identify the epidemiological links between people, animals, and the environment, as part of antimicrobial resistance (AMR) surveillance. In this study, we investigated six wastewater treatment plants (WWTPs) serving six communities located in two regions in Eastern China: Site A in Zhejiang and site B in Jiangsu province to assess the public use of antimicrobial agents (AA). Fifty antimicrobials and 24 of their metabolites were quantified using ultraperformance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS). Spatiotemporal trends were established for measured concentrations, daily loads, and population-normalised daily loads. Daily AA mass loads varied between 1.6 g/day and 324.6 g/day reflecting the WWTP scales, with macrolides and β-lactams showing the highest overall environmental burden at 223.7 g/day and 173.7 g/day, respectively. Emissions of antibiotic residues from manufacturing have been observed, with the peak daily load 12-fold higher than the overall load from a community serving a population of over 600,000. Community exposure levels of 225.2 ± 156.2 mg/day/1000 inhabitant and 351.9 ± 133.5 mg/day/1000 inhabitant were recorded in site A and B, respectively. Paired parent-metabolites analysis identified a large proportion (64–78%) of un-metabolised metronidazole and clindamycin at site B, indicating improper disposal of unused drugs either in the community or in livestock production. Consumption levels, calculated via WBE, suggested relatively low antimicrobial usage in Eastern China compared to other areas in China. This first application of WBE in Eastern China to assess the community-wide exposure to AAs has potential to inform regional antimicrobial stewardship.

AB - Highlights •First application of WBE in Eastern China to assess the community-wide antimicrobials usage. •Spatiotemporal trends in concentrations, daily loads and population-normalised daily loads were measured. •Paired parent and metabolite analysis were included. •Contribution of environmental AMR from antibiotic manufacturing was recognised. Abstract Wastewater-based epidemiology (WBE) has potential to identify the epidemiological links between people, animals, and the environment, as part of antimicrobial resistance (AMR) surveillance. In this study, we investigated six wastewater treatment plants (WWTPs) serving six communities located in two regions in Eastern China: Site A in Zhejiang and site B in Jiangsu province to assess the public use of antimicrobial agents (AA). Fifty antimicrobials and 24 of their metabolites were quantified using ultraperformance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS). Spatiotemporal trends were established for measured concentrations, daily loads, and population-normalised daily loads. Daily AA mass loads varied between 1.6 g/day and 324.6 g/day reflecting the WWTP scales, with macrolides and β-lactams showing the highest overall environmental burden at 223.7 g/day and 173.7 g/day, respectively. Emissions of antibiotic residues from manufacturing have been observed, with the peak daily load 12-fold higher than the overall load from a community serving a population of over 600,000. Community exposure levels of 225.2 ± 156.2 mg/day/1000 inhabitant and 351.9 ± 133.5 mg/day/1000 inhabitant were recorded in site A and B, respectively. Paired parent-metabolites analysis identified a large proportion (64–78%) of un-metabolised metronidazole and clindamycin at site B, indicating improper disposal of unused drugs either in the community or in livestock production. Consumption levels, calculated via WBE, suggested relatively low antimicrobial usage in Eastern China compared to other areas in China. This first application of WBE in Eastern China to assess the community-wide exposure to AAs has potential to inform regional antimicrobial stewardship.

U2 - 10.1016/j.watres.2022.118942

DO - 10.1016/j.watres.2022.118942

M3 - Article (Academic Journal)

C2 - 35944410

SN - 0043-1354

VL - 222

JO - Water Research

JF - Water Research

M1 - 118942

ER -

Assessment of community-wide antimicrobials usage in Eastern China using wastewater-based epidemiology

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