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Translating antibiotic prescribing into antibiotic resistance in the environment: a hazard characterisation case study

Singer, Andrew C. ORCID: https://orcid.org/0000-0003-4705-6063; Xu, Qiuying; Keller, Virginie D.J. ORCID: https://orcid.org/0000-0003-4489-5363. 2019 Translating antibiotic prescribing into antibiotic resistance in the environment: a hazard characterisation case study. PLoS ONE, 14 (9), e0221568. 23, pp. https://doi.org/10.1371/journal.pone.0221568

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Abstract/Summary

The environment receives antibiotics through a combination of direct application (e.g., aquaculture and fruit production), as well as indirect release through pharmaceutical manufacturing, sewage and animal manure. Antibiotic concentrations in many sewage-impacted rivers are thought to be sufficient to select for antibiotic resistance genes. Yet, because antibiotics are nearly always found associated with antibiotic-resistant faecal bacteria in wastewater, it is difficult to distinguish the selective role of effluent antibiotics within a ‘sea’ of gut-derived resistance genes. Here we examine the potential for macrolide and fluoroquinolone prescribing in England to select for resistance in the River Thames catchment, England. We show that 64% and 74% of the length of the modelled catchment is chronically exposed to putative resistance-selecting concentrations (PNEC) of macrolides and fluoroquinolones, respectively. Under current macrolide usage, 115 km of the modelled River Thames catchment (8% of total length) exceeds the PNEC by 5-fold. Similarly, under current fluoroquinolone usage, 223 km of the modelled River Thames catchment (16% of total length) exceeds the PNEC by 5-fold. Our results reveal that if reduced prescribing was the sole mitigating measure, that macrolide and fluoroquinolone prescribing would need to decline by 77% and 85%, respectively, to limit resistance selection in the catchment. Significant reductions in antibiotic prescribing are feasible, but innovation in sewage-treatment will be necessary for achieving substantially-reduced antibiotic loads and inactivation of DNA-pollution from resistant bacteria. Greater confidence is needed in current risk-based targets for antibiotics, particularly in mixtures, to better inform environmental risk assessments and mitigation.

Item Type: Publication - Article
Digital Object Identifier (DOI): https://doi.org/10.1371/journal.pone.0221568
UKCEH and CEH Sections/Science Areas: Pollution (Science Area 2017-)
Water Resources (Science Area 2017-)
Unaffiliated
ISSN: 1932-6203
Additional Information. Not used in RCUK Gateway to Research.: Open Access paper - full text available via Official URL link.
Additional Keywords: antibiotics, antibiotic resistance, rivers, erythromycin, sewage, drug-drug interactions, excretion, water pollution
NORA Subject Terms: Ecology and Environment
Medicine
Date made live: 06 Sep 2019 10:34 +0 (UTC)
URI: http://nora.nerc.ac.uk/id/eprint/525008

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