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Abundance of carbapenemcarbapenem-resistant bacteria in wastewater treatment plant Tomislav Ivankovic, Faculty of Science, University of Zagreb, Croatia Svjetlana Dekic, Faculty of Science, University of Zagreb, Croatia Jasna Hrenovic, Faculty of Science, University of Zagreb, Croatia Marin Ganjto, Zagreb Wastewater - Management and Operation Ltd., Zagreb, Croatia
From 2015 - 2019. project „Natural habitat of clinically important Acinetobacter baumannii” funded by Croatian Science Foundation A. baumannii is an emerging opportunistic pathogen causing hospitalacquired infections, multi-drug resistant, extensive-drug resistant and pandrug resistant carbapenem-resistance in clinical isolates of Acinetobacter baumannii rapidly increased from 10 % in 2008 to 87 % in 2015
One of the tasks was monitoring of carbapenem-resistant bacteria in wastewater treatment plant (WWTP) Carbapenems are beta-lactam class antibiotics, used for treatment of MDR bacterial infections and are widely used in hospital patients Resistance to carbapenems has been worldwide confirmed in Enterobacteriaceae (Klebsiella pneumoniae), Pseudomonas aeruginosa and Acinetobacter baumannii
Abundance of carbapenem-resistant bacterial population (CRBP CRBP) CRBP was monitored during 10 months in major parts of WWTP of city of Zagreb
WWTP – 1 200 000 PE, secondary type treatment (activated sludge) combined sewage consisted of domestic, industrial, hospital and storm wastewaters
20 samplings in total
September 2015. – June 2016.
Total heterotrophic bacteria
Nutrient agar, 22°C / 72h
Slanetz-Bartley agar, 37°C / 72h Confirmed on Bile esculin azide agar 44°C/4 h
CRBP grown at 37°C
CHROMagar Acinetobacter supplemented with CR102 (CHROMagar) after incubation at 37 and 42°C/48 h
CRBP grown at 42°C
Number of bacteria (log CFU ml-1/g-1)
He Ie CR37 CR42
8 7 6 5 4 3 2 1 0 Influent
He Ie CR37 CR42
Ratio to influent (%)
80 60 40 20 0 Influent
He Ie CR37 CR42
Ratio to 60 hetrotrophs (%) 40 20 0 Influent
no physico-chemical parameter was found to have specific influence to CRBP when compared to total bacterial count or abundance of intestinal enterococci as faecal indicators. presence of measured antibiotics (imipenem, meropenem) had no influence on abundance of CRBP in wastewater specifically
WWTP are hotspots for proliferation of drugdrug-resistant bacteria ? conditions in WWTP were considered favourable for proliferation of antibiotic-resistant bacteria and resistance gene transfer (Kim et al. 2007; Huang et al. 2012; Davies 2012; Bouki et al. 2013, Rizzo et al. 2013) In here presented research the CRBP were not favoured in relation to total heterotrophic population or intestinal enterococci during the WWTP process Simillar conclusions to here presented research were reported in Ahmad et al. 2009; Munck et al. 2015; Bengtsson-Palme et al. 2016
Kim S, Jensen JN, Aga SD, Weber SA. 2007. Tetracycline as a selector for resistant bacteria in activated sludge. Chemosphere 66:1643–1651 Huang JJ, Hu HY, Lu SQ, Li Y, Tang F, Lu Y, Wei B. 2012. Monitoring and evaluation of antibiotic-resistant bacteria at a municipal wastewater treatment plant in China. Environ. Int. 42:31–36 Davies J. 2012. Sanitation: sewage recycles antibiotic resistance. Nature 487:302. Bouki C, Venieri D, Diamadopoulos E. 2013. Detection and fate of antibiotic resistant bacteria in wastewater treatment plants: A review. Ecotox. Environ. Saf. 91:1-9. Rizzo L, Manaia C, Merlin C, Schwartz T, Dagot C, Ploy MC, Michael I, Fatta-Kassinos D. 2013. Urban wastewater treatment plants as hotspots for antibiotic re-sistant bacteria and genes spread in to the environment: a review. Sci. Total Environ. 447:345–360. Al-Ahmad A, Hai A,Unger J,Brunswick-Tietze A,Wiethan J, Kummerer K. 2009. Effects of a realistic mixture of antibiotics on resistant and non-resistant sewage sludge bacteria in laboratory-scale treatment plants. Arch. Environ. Contam. Toxicol. 57:264–273. Munck C, Albertsen M, Telke A, Ellaban M, Nielsen PH, Sommer MOA. 2015. Limited dissemination of the wastewater treatment plant core resistome. Nature Comms. 6:8452. Bengtsson-Palme J, Hammaren R, Pal C, Ostman M, Bjorlenius B, Flach CF, Fick J, Kristiansson E, Tysklind M, Larsson DGJ. 2016. Elucidating selection processes for antibiotic resistance in sewage treatment plants using metagenomics. Sci. Total Environ. 572:697-712.
The presence of antibiotics in wastewaters selects in favour of antibiotic resistant bacteria? resistant bacterial strains have selective advantage over susceptible strains even at antibiotic concentrations way lower than respective minimal inhibitory concentration (subMIC) (Liu et al. 2011; Gullberg et al. 2011; Gullberg et al. 2014) Even though imipenem and meropenem concentrations were above the theoretical selective concentration (PNEC) no selective advantage for carbapenem-resistant bacteria was recorded in any part of full-scale WWTP treatment process in here presented research
Liu A, Fong A, Becket E, Yuan J, Tamae C, Medrano L, Maiz M, Wahba C, Lee C, Lee K, Tran KP, Yang H, Hoffman RM, Salih A, Miller JH. 2011. Selective advantage of resistant strains at trace levels of antibiotics: a simple and ultrasensitive color test for detection of antibiotics and genotoxic agents. Antimicrob. Agents. Chemother. 55: 1204–1210. Gullberg E, Albrecht LM, Karlsson C, Sandegren L, Andersson DI. 2014. Selection of a multidrug resistance plasmid by sublethal levels of antibiotics and heavy metals. mBio 5:e01918-14. Gullberg E, Cao S, Berg OG, Ilbäck C, Sandegren L, Hughes D, Andersson DI. 2011. Selection of resistant bacteria at very low antibiotic concentrations. PLoS Pathog. 7:e1002158.
The CRBP was found in all parts of Zagreb WWTP except lime treated stabilized sludge Relative abundance of CRBP when compared to total bacterial count was very similar in influent, activated and digested sludge, and even lowered in effluent No significant correlation was found between any physico-chemical parameter of wastewater or sludge nor carbapenem concentrations in wastewater that would influence CRBP in particular
There was no evidence that Zagreb WWTP selects for CRBP; resistant bacteria were “behaving” as a part of regular microbial flora through all the parts of treatment process 10 months of monitoring showed the importance of effluent and sludge disinfection in preventing dissemination of carbapenem-resistant bacteria to the environment