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The End of Antibiotics? A Call for Physician Action

Medical Alert: Antibiotic resistant bacteria and their antibiotic resistant genes are not only due to medical and veterinarian over-prescribing.

With the evolution of multi-antibiotic resistant bacteria, modern medicine faces the potential loss of one of its most essential tools, antibiotics. Physicians and public health advocates have made great strides in reducing the development of antibiotic resistant bacteria. Now, the identification of antibiotic resistant bacteria (ARB) and their resistant genes in the 3 byproducts of the wastewater treatment plants (biosolids used as a fertilizer amendment on 60% of agricultural land), recycled water (used to irrigate public grass in parks and other playing fields), and effluent (deposited in rivers and oceans) initiates an alarming call for physicians to take action to reduce the spread of antibiotic resistant bacteria and their resistant genes by our wastewater treatment plants.

Medical professionals once led Public Health policy and public infrastructure planning to control the development of antibiotic resistant bacteria (ARB) in clinical settings. Excessive prescription of antibiotics, inadequate hand-washing and improper disposal of antibiotics accelerated the spread of ARB and their antibiotic resistant genes. Physicians and other health care professionals have sought to reduce the unnecessary use of antibiotics and ensure appropriate disposal of unused drugs.

By focusing only in private practice, clinics and hospitals on the spread of ARB and their antibiotic resistant genes, physicians generally have not been aware of the inadvertent proliferation of ARB and their antibiotic resistant genes by wastewater treatment plants.

A Medical Hydropathology Working Group, which includes a physician and 2 other researchers, has tested recycled water from two wastewater treatment sewer plants in southern California. The testing documented the presence of antibiotic resistant bacteria and their antibiotic resistant genes. Some of these contaminants are even resistant to vancomycin, the medication used to treat methicillin resistant Staphylococcus aureus (MRSA).

Healthcare professionals must address this threat to public health if we want to continue to retain antibiotics as tools.

Modern medicine without antibiotics?

Since penicillin was first discovered in 1929, antibiotics have been a critical tool of modern medicine. During WWII, penicillin was widely used to treat bacterial infection. Other antibiotics are commonly utilized preventatively after surgery as well as for the treatment of various wounds. Prior to the availability of antibiotics, doctors were forced to amputate limbs to prevent the spread of infections. Minor cuts or strep throat might have become fatal. Unfortunately, scientists recently began to recognize that antiobiotic resistant pathogens were laterally transferring (both within wastewater treatment plants and out in the environment at large) their resistant genes between strains and even between species. Today,more people die from MSRA than from AIDS.

Antibiotic resistance is a simple evolutionary adaptation. Resistant Genes can be passed on in three ways. First, direct gene transfer via cell-to-cell contact. Second, a bacteriophage can introduce new DNA into a bacteria during a viral infection. Third, a disruption of bacterial cell walls may facilitate the uptake of naked or free floating DNA. The reproductive capacity of resistant bacteria that live in animal and human intestines, constantly expand, thus making it increasingly difficult for antibiotics to eliminate such pathogens. Approximately 70% of the bacteria that cause infections in hospitals are resistant to many of the most commonly utilized antibiotics.

Why are water resources contaminated with ARB and their antibiotic resistant genes?

One explanation is that sewage treatment inadvertently promotes lateral transfer from antibiotic resistant pathogens in the untreated wastewater to the digestive bacteria utilized in the wastewater treatment process. Wastewater is treated to meet minimal federal standards.  Although the—the three by-products of the wastewater treatment plants are not intended for direct human consumption, we may eat crops fertilized with biosolids as well as animals that graze on pasture lands. We play on public grass irrigated with treated recycled water. In essence, humans are regularly and inadvertentlyexposed to treated wastewater as suggested by the above preliminary research data.

As the supply of potable water decreases, public pressure to identify alternative ways to use recycled water increases. Elected officials and administrators are eager to use recycled water to irrigate municipal grass and even to put out major fires.

While presumably designed to remove harmful bacteria and micro-organisms wastewater treatment plants should, theoretically, be able to protect public health from dangerous bacteria and their antibiotic resistant genes.  Physicians and other health care professions must begin to publically raise the above concerns.

Policy changes are critical to prevent illness and suffering

If recycled water and the other treated sewage byproducts contains ARB and their antibiotic resistant genes, regulatory processes at the federal, state and local levels must prevent presently treated recycled water from being reconverted to potable water as well as utilized to irrigate crops consumed raw to fight fires or to irrigate parks and playgrounds. For the sake of public health, we must monitor and regulate the ARB and their antibiotic resistant genes. The Federal Clean Water Act, the principle law covering how sewer plants operate, does not require wastewater treatment plants to document levels of ARB and their antibiotic resistant genes. Local, state and municipal governments are free to regulate and even sell the use of recycled water and biosolids.

All sewer plants in California utilize the same wastewater treatment and discharge protocol. Such protocol do not consider antibiotic resistance, its transfer of genetic information to digestive bacteria nor does the testing of treated biosolids, recycled water and  the treated potable water in the purple delivery pipes consider the phenomenon of viable but non-culturable.

Health care professionals and their scientific colleagues should conduct additional independent research of ARB levels and their antibiotic resistant genes in effluent, biosolids and recycled water to make the case for increased regulation. We must simultaneously pressure our elected officials and California state agencies to develop methods to quantify ARB and their resistant antibiotic genes in the environment and then to develop more appropriate treatment for ARB and their antibiotic resistant genes by wastewater treatment facilities.

Resources

For more research on the history of sewer plant generation of antibiotic resistance, please explore the following articles/links:

  • National Research Council, Biosolids Applied to Land: Advancing Standards and Practices, July 2, 2002
  • Pruden, Amy et al. “Antibiotic Resistance Genes as Emerging Contaminants:  Studies in Northern Colorado, ”Environmental Science & Technology 40.23 (2006): 7445–7450. Web. 28 June 2012.
  • ISDA, “Bad Bugs, No Drugs, as Antibiotic Discovery Stagnates…A Public Health Crisis  Brews,” Infectious Diseases Society of America, July 2004.
  • Todar, K.. “Pathogenic E. coli”.Online Textbook of Bacteriology. University of Wisconsin–Madison Department of Bacteriology. Retrieved 2007-11-30.
  • McLain, Jean E.T. “Development of Antibiotic Resistance in Bacteria of Soils Irrigated with Reclaimed Wastewater.”
  • “Recycled Water – Purple Pipe.” 4 Feb 2009. Online image. LADWP. 7 July 2012. http://www.flickr.com/photos/ladwp/3945773182/
  • “WHO | World Health Day 2011: policy briefs,” WHO. [Online]. Available:http://www.who.int/world-health-day/2011/policybriefs/en/index.html. [Accessed: 02-Aug-2012].
  • Meckes, Mark. Effect of UV Light Disinfection on Antibiotic-Resistant Coliforms in Wastewater Effluents. APPLIED AND ENVIRONMENTAL MICROBIOLOGY. Feb. 1982, p. 371-377

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