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Hospital wastewater releases of carbapenem-resistance pathogens and genes in urban India

Lookup NU author(s): Manisha Lamba, Professor David Graham



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Increasing antibiotic resistant hospital-acquired infections and limited new antibiotic discovery are jeopardizing human health at global scales, although how hospitals themselves fuel AMR in the wider environment is largely unknown. Antibiotic resistance (AR) from hospitals in countries like India is potentially problematic because of high antibiotic use, overcrowding, and inadequate wastewater containment. Here we quantified fecal coliforms (FC), carbapenem-resistant Enterobacteriaceae (CRE), blaNDM-1, and selected extended-spectrum β-lactam (ESBL) resistant bacteria and genes in 12 hospital wastewater outfalls and five background sewer drains across New Delhi over two seasons. Hospital wastewaters had up to nine orders of magnitude greater concentrations of CRE bacteria and blaNDM-1 than local sewers (depending on the hospital), implying hospitals contribute high concentrations of AR relative to community sources in Delhi, especially during the winter. Significant correlations were found between FC levels (a fecal indictor), and CRE (r =0.924; p =0.005), blaNDM-1 (r=0.934, p=0.009), and ESBL-resistant bacteria (r=0.913, p=0.010) levels across hospital wastewaters, respectively, imp-lying elevated CRE and blaNDM-1 are of patient origin. However, of greater importance to global health, microbial culturing found 18 to 41% of wastewater CRE isolates (n =1447) were on the WHO “critical pathogen” list in urgent need of new antibiotics, and 55% of CRE isolates from larger hospitals carried at least one blaNDM-1 gene. Wastewater releases from New Delhi hospitals may pose a greater AR exposure risk to residents than believed, implying in-hospital antibiotic use must be better controlled and more effective waste treatment is needed for hospital wastewaters.

Publication metadata

Author(s): Lamba M, Graham DW, Ahammad SZ

Publication type: Article

Publication status: Published

Journal: Environmental Science & Technology

Year: 2017

Volume: 51

Issue: 23

Pages: 13906–13912

Print publication date: 05/12/2017

Online publication date: 26/09/2017

Acceptance date: 26/09/2017

Date deposited: 14/10/2017

ISSN (print): 0013-936X

ISSN (electronic): 1520-5851

Publisher: American Chemical Society


DOI: 10.1021/acs.est.7b03380

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