Transcript 2011 National Environmental Health Association Meeting Crispin Pierce, Sasha Showsh, and Eli Gottfried (faculty) Tola Ekunsanmi, Michael Checkai, Jay Nielsen, Jacob Schafer, Michael Servi.

2011 National Environmental Health Association
Meeting
Crispin Pierce, Sasha Showsh, and Eli Gottfried (faculty)
Tola Ekunsanmi, Michael Checkai, Jay Nielsen, Jacob
Schafer, Michael Servi and Matt Haak (students)
University of Wisconsin-Eau Claire



Background
Antibiotic Resistance from Land Spreading?
Antibiotic Resistance in Septic Effluent





Big box store
Chain restaurant
Rehabilitation and Convalescent Center
Surveillance and Control
Summary of Control Measures
 Antibiotic resistance is evident when a drug
can no longer inhibit the growth of the target
bacteria.
 Resistance may be natural or as a result of
mutation of existing genetic material
acquiring new genetic material.
 Feed additives, including antibiotics, are used
to promote growth of livestock enter the food
chain.
 Widespread human use of antibiotics is also
associated with antibiotic resistance.
 According to the National Nosocomial Infections
Surveillance (NNIS) System data on intensive care units
(ICUs) in the U.S, 28.5% of enterococci associated with
nosocomial infections were resistant to vancomycin,
31.9% of Pseudomonas aeruginosa were resistant to
ceftazidime and 60% of Staphylococcus aureus isolates
were resistant to methicillin (i.e. MRSA) (1).
 More than 80 pharmaceuticals and drug metabolites,
have been measured in μg/l-levels in sewage samples
and downstream surface waters. (2)
 Recent research has shown certain bacteria may
survive on a diet of the antibiotic Vancomycin. (3)


The improper disposal and overuse of
antibiotics accelerates the spread of antibioticresistant bacteria.
Nontherapeutic use of antibiotics in animal
production is estimated to be the cause of
about 70% of antibiotic resistance (4).
When food animals are treated with antibiotics
to speed growth or compensate for dirty,
crowded and stressful conditions, bacteria
resistant to these drugs proliferate and enter
humans through meat consumption. Similarly,
over-prescription and improper disposal of
antibiotics lead to ground and surface water
contamination, and entry into humans from
drinking water. (Photo: agmates.com)
Transmission of antibiotic-resistant bacteria
is highest in confined populations such as
hospitalized patients, college students living
in dormitories, prison inmates, and athletes
(football players on artificial turf have 15-fold
higher prevalence rates). Populations most
likely to develop disease and death are
children, elderly, and immune-compromised
individuals. (Photo:
http://abopposito.blogspot.com/)
These bacteria in turn cause extensive disease and
death: methicillin-resistant staphylococcus aureus
(MRSA) alone causes 15–20,000 deaths in the
United States each year (4).
Hypothesis: Agricultural fields receiving land
spreading of septic system effluent will have
higher levels of antibiotic resistant bacteria than
fields without spreading.
Thirteen soil samples (7 control and 6 treated)
were collected from a crop field near Eau
Claire treated with septic system effluent
(Figs. 1 and 2). These samples were mixed
with water and plated on Colombian Blood
Agar and four antibiotics (chloramphenicol,
tetracycline, erythromycin and ampicillin, Fig.
3).
Fig. 1 Land spreading of septic
tank effluent.
http://www.limemaster.com/Land_Spreading.html
Although the fraction of antibiotic-resistant
colonies tended to be higher for control vs.
treated samples, this apparent difference did
not reach a significance of p<0.05 (one-tailed
t-test, equal variance, Fig. 4).
Fig. 4 Colony growth and fraction of antibiotic resistance in control and treated
(septic effluent-applied) samples for five antibiotics.
In this small study, treatment of an
agricultural field with septic system effluent
did not significantly change the fraction of
bacteria that were resistant to five antibiotics
(Kanamycin, Tetracycline, Eosine Methylene
Blue, Erythromycin and Ampicillin).
Bacterial antibiotic resistance generated from
a large retail store, small chain restaurant and
convalescent home was measured. Several
samples of effluent from the respective septic
systems were analyzed for bacterial resistance
to ampicillin, kanamycin, tetracycline, and
erythromycin.
The restaurant contained higher levels of
resistance to ampicillin, kanamycin, and
tetracycline than the store or convalescent
home, with an average of 51.79%, 27.54%,
and 30.78% of microbial growth resistant to
the respective antibiotics.
Erythromycin resistance was highest in
effluent discharged from the convalescent
home at 22% compared to the store at 7.00%
and restaurant at 2.87%.
Our research analyzed wastewater effluent from a
rehabilitation and convalescent facility, a “bigbox” store, a local chain restaurant, and septic
sewage spread agricultural and untreated soils.
We found that wastewater and soil samples
contained fractions of antibiotic resistant bacteria
from 0.5—52%.
Wisconsin State Division of Health:


Information for Health Care Providers
Antibiotic Resistance Report


Surveillance of hospital and non-hospital
incidence and prevalence.
Appropriate use of antibiotics:
 Use
only when needed
 Proper disposal
 Legislation to limit non-therapeutic use in animals.

Sanitation
1. Wisconsin Division of Public Health Bureau of Communicable Diseases and Preparedness
Guidelines for Prevention and Control of Antibiotic Resistant Organisms in Health Care Settings,
September, 2005.
2. Herberer, Thomas. "Toxicology Letters: Occurrence, Fate, and Removal of Pharmaceutical
Residues in the Aquatic Environment: a Review of Recent Research Data." ScienceDirect. 15 Mar.
2002. Toxicology Letters. 7 Apr. 2008
3. "Antibiotic-eating germ alarms doctors - Enterococcus faecium bacterium survives on diet of the
antibiotic vancomycin - Biomedicine - Brief Article". Science News. Dec 21, 1996.
4. Pew Charitable Trusts. “Human Health and Antibiotic use in Industrial Farming” 2010.
Additional References
Paterson, David . "Update on Antibiotic Resistance in Hospitals." The Prevalence of Antibiotic
Resistance in the Hospital Setting. 2006. 20 Apr 2007
<http://www.medscape.com/editorial/cmetogo/5541>.
Fridkin, Scott K. et al. "Temporal Changes in Prevalence of Antimicrobial Resistance in 23 U.S.
Hospitals." Emerging Infectious Diseases Vol. 8, No. 7,(2002): 697-701.
Lipsitch, Marc. "The epidemiology of antibiotic resistance in hospitals:Paradoxes and prescriptions."
PNAS vol.97(2000): 1938-1943.
Contact Information
•
•
•
•
•
•
•
•
•
Crispin H. Pierce, Ph.D.
Associate Professor / Program Director
Department of Public Health Professions
244 Nursing
University of Wisconsin - Eau Claire
Eau Claire, WI 54702-4004
(715) 836-5589
http://www.uwec.edu/piercech
http://www.uwec.edu/ph/enph/