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Sewage from a secondary hospital in Ribeirão Preto, southeastern Brazil: a source of multidrug-resistant Enterobacteriaceae

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Abstract

Antimicrobial resistance is one of the severe threats to global health. Hospital sewage can serve as a reservoir for multi-resistant bacteria and promote the spread of antimicrobial resistance. This study aimed to investigate the antimicrobial susceptibility and the pathogenic potential of Enterobacteriaceae isolated from the sewage of a secondary hospital in Ribeirão Preto, a city in southeastern Brazil. The strains were isolated by membrane filtration and identified by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF). The antimicrobial susceptibility profile was performed by disk diffusion. Polymerase chain reaction (PCR) assays were used to detect virulence genes among the strains. Twenty-eight isolates were obtained, with Klebsiella pneumoniae being the predominant species (71.4%, n = 20). All isolates were classified as multidrug-resistant, including four isolates that were non-susceptible to at least 50% of the tested antibiotics. All isolates were also non-susceptible to cefuroxime and sulfonamides antibiotics; however, they were susceptible to norfloxacin, ofloxacin, amikacin, gentamicin, netilmicin, ertapenem, cefazolin, cefaclor, and cefotetan. The virulence genes ycfM, fimH, mrkD, kfu, and entB were detected in several isolates. Our study showed that even in a secondary hospital, without the routine of major surgeries and intensive care admissions, the hospital sewage can harbor a high percentage of multidrug-resistant bacteria with pathogenic potential. This leads to the worrying risk of public health and environmental contamination.

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Acknowledgements

The authors would like to thank Enago (www.enago.com) for the English language review.

Funding

This work was supported by the São Paulo State Research Support Foundation (FAPESP) (Grant no. 2013/22581–5). RN-S is a Ph.D. student fellow of Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES); therefore, this study was financed in part by the CAPES (grant no 88882365161 and Finance Code 001).

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Authors and Affiliations

  1. Programa de Pós-Graduação em Tecnologia Ambiental, Universidade de Ribeirão Preto–UNAERP, Bloco J, Laboratório 1, Av. Costábile Romano, 2201, São Paulo 14096‑900, Ribeirânia, Ribeirão Preto, Brazil

    Rafael Nakamura-Silva & André Pitondo-Silva

  2. Empresa Brasileira de Pesquisa Agropecuária–EMBRAPA, Unidade Tabuleiros Costeios, Av. Beira Mar, 3250 Jardins, Sergipe, 49025040, Aracaju, Brazil

    Ricardo Coelho de Sousa & Rodrigo Yudi Fujimoto

Authors
  1. Rafael Nakamura-Silva
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  2. Ricardo Coelho de Sousa
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  3. Rodrigo Yudi Fujimoto
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  4. André Pitondo-Silva
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Contributions

RN-S: conceptualized and designed the study, collected the samples, performed experiments, and analyzed and prepared this manuscript; RCdeS and RYF: performed the identification of isolated strains; AP-S: conceptualized and designed the study, formal analysis, supervision, project administration, and funding acquisition. All authors reviewed and approved the final manuscript.

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Correspondence to André Pitondo-Silva.

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Nakamura-Silva, R., de Sousa, R.C., Fujimoto, R.Y. et al. Sewage from a secondary hospital in Ribeirão Preto, southeastern Brazil: a source of multidrug-resistant Enterobacteriaceae. Environ Monit Assess 195, 204 (2023). https://doi.org/10.1007/s10661-022-10830-1

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