Promoting Resistance by the Emission of Antibiotics from Hospitals and Households into Effluent

Klaus Kümmerer; A. Henninger

doi:10.1111/j.1469-0691.2003.00739.x

Promoting Resistance by the Emission of Antibiotics from Hospitals and Households into Effluent

Klaus Kümmerer
, A. Henninger

University Hospital Freiburg

Research output: Journal contributions › Journal articles › Research › peer-review

511 Citations (Scopus)

Abstract

Objective. There is growing concern about bacterial resistance to antimicrobials. The majority of antibiotics used are only partially metabolized after administration, and are released via patient excreta into the municipal sewage system. Data on the use of antibiotics and their emission into hospital effluent are not available. Methods. Antibiotic consumption in Germany was calculated on the basis of five hospitals of varying size and medical service spectrum and on prescriptions issued by medical practitioners. The predicted environmental concentration (PEC) was calculated for hospital effluent and for municipal sewage. The PECs were compared both with published minimum inhibitory concentrations (MIC ₅₀) for sensitive pathogenic bacteria and with the predicted no-effect concentrations (PNECs). Results. The amount of antibiotics emitted into hospital effluent may reach and exceed the MIC ₅₀ of susceptible pathogenic bacteria. The PEC/PNEC ratio is highest for hospital effluent (in some cases 10-20 times the MIC ₅₀) and frequently >1 for municipal sewage. PECs are high enough for some compounds to have a PEC/PNEC ratio >1 even in surface water. Conclusion. The volume of antibiotics used in hospitals and private households and released into effluent and municipal sewage indicates a selection pressure on bacteria. Steps should be taken to reduce the risk by proper handling of antibiotics and their residues both in hospitals and by private users.

Original language	English
Journal	Clinical Microbiology and Infection
Volume	9
Issue number	12
Pages (from-to)	1203-1214
Number of pages	12
ISSN	1198-743X
DOIs	https://doi.org/10.1111/j.1469-0691.2003.00739.x
Publication status	Published - 01.12.2003
Externally published	Yes

Bibliographical note

Funding Information:
We wish to thank E. Strehl, M. Herrel and W. Kohnen for their help in providing data on antibiotic use in the investigated hospitals. Our thanks also go to T. Erbe for providing some of the calculations. Takeda Pharma kindly supplied the figures on patented substance production. The work presented was supported by the Forschungs-kommission des Universitätsklinikums Freiburg (Research Commission of the University Hospital of Freiburg) and by the Ministerium für Forschung und Bildung (Ministry of Research and Education, Grant 02WU987/12) as well as by the Umweltbundesamt (Federal Environmental Protection Agency, Grants F and E 298 63722). Some of the work was supported by the European Community (LIFE 99 ENV/D/000455).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research areas and keywords

Chemistry

ASJC Scopus Subject Areas

Infectious Diseases
Microbiology (medical)

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Cite this

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title = "Promoting Resistance by the Emission of Antibiotics from Hospitals and Households into Effluent",

abstract = "Objective. There is growing concern about bacterial resistance to antimicrobials. The majority of antibiotics used are only partially metabolized after administration, and are released via patient excreta into the municipal sewage system. Data on the use of antibiotics and their emission into hospital effluent are not available. Methods. Antibiotic consumption in Germany was calculated on the basis of five hospitals of varying size and medical service spectrum and on prescriptions issued by medical practitioners. The predicted environmental concentration (PEC) was calculated for hospital effluent and for municipal sewage. The PECs were compared both with published minimum inhibitory concentrations (MIC 50) for sensitive pathogenic bacteria and with the predicted no-effect concentrations (PNECs). Results. The amount of antibiotics emitted into hospital effluent may reach and exceed the MIC 50 of susceptible pathogenic bacteria. The PEC/PNEC ratio is highest for hospital effluent (in some cases 10-20 times the MIC 50) and frequently >1 for municipal sewage. PECs are high enough for some compounds to have a PEC/PNEC ratio >1 even in surface water. Conclusion. The volume of antibiotics used in hospitals and private households and released into effluent and municipal sewage indicates a selection pressure on bacteria. Steps should be taken to reduce the risk by proper handling of antibiotics and their residues both in hospitals and by private users. ",

keywords = "ANTIBIOTIC, Antibiotics, antimicrobial, antimicrobials, bacteria, BACTERIAL, BACTERIAL-RESISTANCE, BACTERIUM, COMPOUND, concentration, CONSUMPTION, effluent, Emission, environmental, GERMANY, hospital, hospital effluent, HOSPITALS, Method, Methods, MUNICIPAL SEWAGE, PATIENT, PEC, PNEC, predicted environmental concentration, predicted no-effect concentration, prescriptions, REACh, residue, RESIDUES, RESISTANCE, risk, SELECTION, sewage, SIZE, SPECTRA, SURFACE, surface water, SURFACE-WATER, SYSTEM, WATER, Chemistry",

author = "Klaus K{\"u}mmerer and A. Henninger",

note = "Funding Information: We wish to thank E. Strehl, M. Herrel and W. Kohnen for their help in providing data on antibiotic use in the investigated hospitals. Our thanks also go to T. Erbe for providing some of the calculations. Takeda Pharma kindly supplied the figures on patented substance production. The work presented was supported by the Forschungs-kommission des Universit{\"a}tsklinikums Freiburg (Research Commission of the University Hospital of Freiburg) and by the Ministerium f{\"u}r Forschung und Bildung (Ministry of Research and Education, Grant 02WU987/12) as well as by the Umweltbundesamt (Federal Environmental Protection Agency, Grants F and E 298 63722). Some of the work was supported by the European Community (LIFE 99 ENV/D/000455).",

year = "2003",

month = dec,

day = "1",

doi = "10.1111/j.1469-0691.2003.00739.x",

language = "English",

volume = "9",

pages = "1203--1214",

journal = "Clinical Microbiology and Infection",

issn = "1198-743X",

publisher = "Elsevier B.V.",

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}

TY - JOUR

T1 - Promoting Resistance by the Emission of Antibiotics from Hospitals and Households into Effluent

AU - Kümmerer, Klaus

AU - Henninger, A.

N1 - Funding Information: We wish to thank E. Strehl, M. Herrel and W. Kohnen for their help in providing data on antibiotic use in the investigated hospitals. Our thanks also go to T. Erbe for providing some of the calculations. Takeda Pharma kindly supplied the figures on patented substance production. The work presented was supported by the Forschungs-kommission des Universitätsklinikums Freiburg (Research Commission of the University Hospital of Freiburg) and by the Ministerium für Forschung und Bildung (Ministry of Research and Education, Grant 02WU987/12) as well as by the Umweltbundesamt (Federal Environmental Protection Agency, Grants F and E 298 63722). Some of the work was supported by the European Community (LIFE 99 ENV/D/000455).

PY - 2003/12/1

Y1 - 2003/12/1

N2 - Objective. There is growing concern about bacterial resistance to antimicrobials. The majority of antibiotics used are only partially metabolized after administration, and are released via patient excreta into the municipal sewage system. Data on the use of antibiotics and their emission into hospital effluent are not available. Methods. Antibiotic consumption in Germany was calculated on the basis of five hospitals of varying size and medical service spectrum and on prescriptions issued by medical practitioners. The predicted environmental concentration (PEC) was calculated for hospital effluent and for municipal sewage. The PECs were compared both with published minimum inhibitory concentrations (MIC 50) for sensitive pathogenic bacteria and with the predicted no-effect concentrations (PNECs). Results. The amount of antibiotics emitted into hospital effluent may reach and exceed the MIC 50 of susceptible pathogenic bacteria. The PEC/PNEC ratio is highest for hospital effluent (in some cases 10-20 times the MIC 50) and frequently >1 for municipal sewage. PECs are high enough for some compounds to have a PEC/PNEC ratio >1 even in surface water. Conclusion. The volume of antibiotics used in hospitals and private households and released into effluent and municipal sewage indicates a selection pressure on bacteria. Steps should be taken to reduce the risk by proper handling of antibiotics and their residues both in hospitals and by private users.

AB - Objective. There is growing concern about bacterial resistance to antimicrobials. The majority of antibiotics used are only partially metabolized after administration, and are released via patient excreta into the municipal sewage system. Data on the use of antibiotics and their emission into hospital effluent are not available. Methods. Antibiotic consumption in Germany was calculated on the basis of five hospitals of varying size and medical service spectrum and on prescriptions issued by medical practitioners. The predicted environmental concentration (PEC) was calculated for hospital effluent and for municipal sewage. The PECs were compared both with published minimum inhibitory concentrations (MIC 50) for sensitive pathogenic bacteria and with the predicted no-effect concentrations (PNECs). Results. The amount of antibiotics emitted into hospital effluent may reach and exceed the MIC 50 of susceptible pathogenic bacteria. The PEC/PNEC ratio is highest for hospital effluent (in some cases 10-20 times the MIC 50) and frequently >1 for municipal sewage. PECs are high enough for some compounds to have a PEC/PNEC ratio >1 even in surface water. Conclusion. The volume of antibiotics used in hospitals and private households and released into effluent and municipal sewage indicates a selection pressure on bacteria. Steps should be taken to reduce the risk by proper handling of antibiotics and their residues both in hospitals and by private users.

KW - ANTIBIOTIC

KW - Antibiotics

KW - antimicrobial

KW - antimicrobials

KW - bacteria

KW - BACTERIAL

KW - BACTERIAL-RESISTANCE

KW - BACTERIUM

KW - COMPOUND

KW - concentration

KW - CONSUMPTION

KW - effluent

KW - Emission

KW - environmental

KW - GERMANY

KW - hospital

KW - hospital effluent

KW - HOSPITALS

KW - Method

KW - Methods

KW - MUNICIPAL SEWAGE

KW - PATIENT

KW - PEC

KW - PNEC

KW - predicted environmental concentration

KW - predicted no-effect concentration

KW - prescriptions

KW - REACh

KW - residue

KW - RESIDUES

KW - RESISTANCE

KW - risk

KW - SELECTION

KW - sewage

KW - SIZE

KW - SPECTRA

KW - SURFACE

KW - surface water

KW - SURFACE-WATER

KW - SYSTEM

KW - WATER

KW - Chemistry

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U2 - 10.1111/j.1469-0691.2003.00739.x

DO - 10.1111/j.1469-0691.2003.00739.x

M3 - Journal articles

SN - 1198-743X

VL - 9

SP - 1203

EP - 1214

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

IS - 12

ER -

Promoting Resistance by the Emission of Antibiotics from Hospitals and Households into Effluent

Abstract

Bibliographical note

UN SDGs

Research areas and keywords

ASJC Scopus Subject Areas

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