Exposure to benzalkonium chloride disinfectants promotes antibiotic resistance in sewage sludge microbiomes

Removal of antibiotic and disinfectant compounds from digested pig manure by an aerobic hybrid biofilm process

Using nutrient-rich manure as fertiliser on agricultural land improves crop yield, biodiversity, soil structure, water and nutrient availability. However, manure often contains high levels of antibiotics, as only 10-30 % are metabolised by the animal, thus, soil application contributes to the spread of antibiotics and antibiotic-resistant genes (ARGs). As anaerobic digestion fails to remove the antibiotics and ARGs completely, this study investigates aerobic moving bed biofilm reactors (MBBRs) as post-treatment. The dissipation of sulfadiazine, sulfamethoxazole, ofloxacin, ciprofloxacin, roxithromycin, erythromycin, tylosin, tetracycline, chlortetracycline, benzalkonium chloride C12 and -C14 (BAC-12 and -14) was observed in small laboratory batch MBBRs with digested pig manure. Proficiency testing resulted in an overall removal of 92 %. Sulfamethoxazole and erythromycin were removed by >99 % within 12 and 23 days, respectively. The digestate exhibited high concentrations of benzalkonium biocides, i.e., BAC-12 and -14 (800 μg/L and 172 μg/L, respectively), highlighting the necessity for post-treatment before application to agricultural soil. Within 23 days, the aerobic MBBRs achieved 89 % and 93 % degradation of BAC-12 and -14, respectively. The biofilms improved the total removal by 19 % and BAC degradation by 61-68 % while increasing bacterial diversity. The MBBR-operation increased the abundance of the genera Paracoccus, Parvibaculum, and Clostridium sensu stricto 1. The sulfonamide-resistance genes were the most abundant ARGs (96 % and 98 % in the sludge and carrier biofilm, respectively). The ARG-abundance increased after antibiotic spiking and declined during incubation, reducing direct ARG spread to the environment by degrading antimicrobial concentrations. We, therefore, propose to treat anaerobically digested manure by aerobic biofilm treatment for antibiotic removal.

Reviewing the complexities of bacterial biocide susceptibility and in vitro biocide adaptation methodologies

Decreased bacterial susceptibility to biocides raises concerns due to their influences on antibiotic resistance. The lack of standardized breakpoints, established methods, and consistent terminology complicates this research. This review summarizes techniques for studying biocide resistance mechanisms, susceptibility testing, and in-vitro adaptation methods, highlighting their benefits and limitations. Here, the challenges in studying biocide susceptibility and the need for standardized approaches in biocide research are emphasized for commonly studied biocide classes.

Degradation of N-methylbenzylamine and N,N-dimethylbenzylamine in anaerobic biological reactors and formation of N-nitrosomethylbenzylamine and N-nitrosodimethylamine during subsequent chloramination

As water reuse demand increases, wastewater treatment plants must manage byproducts effectively while ensuring safety. The excessive use of benzalkonium chloride disinfectants can lead to the accumulation of benzylamines, such as N-methylbenzylamine (MBA) and N,N-dimethylbenzylamine (DMBA). Biological anaerobic treatment is becoming more popular due to concerns over energy consumption and carbon emissions. Our study examined the biodegradation of MBA and DMBA during anaerobic treatment and their effects on toxic byproduct formation during subsequent chloramination, as well as their impact on bioreactor performance, degradation pathways, and microbial communities. Our results showed that anaerobic bioreactors had minimal impact on overall treatment performance despite the presence of MBA and DMBA. MBA proved resistant to biodegradation, whereas DMBA underwent significant biodegradation. Notably, during chloramination, MBA effluent formed nitroso-MBA with a 1 % molar yield, whereas DMBA effluent had significant N-nitrosodimethylamine formation, with molar yields reaching 10 ± 1 % and 97 ± 7 % of the influent and residual DMBA concentrations. We observed significant differences in microbial communities between the DMBA reactor and the MBA and control reactors. Proposed degradation pathways and the involvement of specific microbial communities were detailed. These findings highlight the importance of thoroughly evaluating biologically treated effluent to manage the risks of toxic byproducts in water reuse.

Detection and Analysis of Drug and Disinfectant Resistance Genes in the Sewage of a Center for Disease Control and Prevention

Purpose

Sewage is a significant reservoir for drug and disinfectant resistance genes and a medium for dissemination. This study aimed to evaluate the presence of drug and disinfectant resistance genes in the sewage of a Center for Disease Control and Prevention (CDC) and to assess the risks of their dissemination.

Methods

Sewage from a CDC in Hangzhou was collected, filtered, and enriched, and its microorganisms were cultured. The isolated bacteria were identified, and the minimum inhibitory concentration (MIC) was determined. The drug and disinfectant resistance genes in the sewage and bacteria were detected through polymerase chain reaction amplification.

Results

Three kinds of bacteria were isolated from the sewage sample. The MIC for Sphingomonas and Staphylococcus xylosus against chlorine-containing disinfectants was 250 mg/L, whereas the MIC for Bacillus firmus was 500 mg/L. The β-lactam resistance gene TEM and the disinfectant resistance gene qacA were positive in the bacteria, whereas the β-lactam resistance genes TEM, SHV, and VIM-1, the tetracycline resistance gene tetM, the aminoglycoside resistance genes aac(6')/aph(2') and aph3'-III, and the disinfectant resistance genes qacA, qacE, and qacEΔ1 were positive in the sewage.

Conclusion

Drug and disinfectant resistance genes were found in the sewage of a CDC and were associated with bacteria. Thus, optimizing the monitoring and treatment of sewage is crucial.

Assessing the distribution and human health risks of cationic surface-active agents in honey from China

Cationic surface-active agents (CSAAs) can persist in ambient water, be ingested by bees, and contaminate honey. Residues of CSAAs in honey remains unknown. This study measured the residual levels of five CSAAs in 271 honey samples from China using ultrahigh-performance liquid chromatography coupled with triple-quadrupole tandem mass spectrometry. Residual benzalkonium chloride-C12 (BAC-C12), BAC-C14, BAC-C16, chlorhexidine (CHG), and 4-chloraniline levels were 0.0098-2.1468, 0.0061-1.7492, 0.0012-1.6305, 0.1576-0.8401, and 0.0019-0.0234 μg kg-1, respectively. CHG and all BAC were detected in 100 % of Z. jujuba, V. negundo var. heterophylla, wildflower, L. chinensis, and D. longan Lour honey; T. tuan honey had the lowest detection rate of any CSAAs. BAC-C16 had the highest residual level among all BAC tested in Central, North China. CHG levels were detected in 91.38 % of samples in North China and 100 % in East China. BAC-C12 was significantly higher in A. cerana versus A. mellifera honey (P < 0.001). Hazard quotient and Hazard index values indicate that CSAAs residuals in honey do not pose a health risk. Correlation analysis revealed a positive correlation between BACs resides in honey and surrounding environment. The findings suggest that continuous monitoring of CSAAs in honey is imperative to ensure its safety for human consumption, while also serving as an effective matrix to assess the environmental pollution of a given region.

Knowledge, attitudes, and practice of medical students towards the use of benzalkonium chloride in hand sanitization from the perspective of environmental sustainability

Control measures for disinfectant pollution and related anthropogenic behaviors are required. Benzalkonium chloride (BAC) with widespread use especially in hand sanitization is highlighted as a representative disinfectant emerging contaminant. This cross-sectional survey was conducted to assess the knowledge, attitudes, practice regarding BAC use for hand hygiene among medical students from the perspective of environmental sustainability. Of the 703 responding students, only 3.7% had never used hand sanitizer products containing BAC. But few students paid attention to the "environmental friendliness" property of products when consumption. Mean knowledge test score was 1.90 out of 5, suggesting poor knowledge regarding BAC use. Most students had positive attitudes toward source control of BAC pollution and strong intentions to learn more about environmental knowledge related to BAC and other disinfectants. Data indicated that medical students had positive attitudes but lacked knowledge and practices towards eco-friendly disinfectant use, thus further training and practice standards are required.

Transfer dynamics of antimicrobial resistance among gram-negative bacteria

Antimicrobial resistance (AMR) in gram-negative bacteria (GNBs) is a significant global health concern, exacerbated by mobile genetic elements (MGEs). This review examines the transfer of antibiotic resistance genes (ARGs) within and between different species of GNB facilitated by MGEs, focusing on the roles of plasmids and phages. The impact of non-antibiotic chemicals, environmental factors affecting ARG transfer frequency, and underlying molecular mechanisms of bacterial resistance evolution are also discussed. Additionally, the study critically assesses the impact of fitness costs and compensatory evolution driven by MGEs in host organisms, shedding light on the transfer frequency of ARGs and host evolution within ecosystems. Overall, this comprehensive review highlights the factors and mechanisms influencing ARG movement among diverse GNB species and underscores the importance of implementing holistic One-Health strategies to effectively address the escalating public health challenges associated with AMR.

Benzalkonium chloride induces hematopoietic stem cell reduction and immunotoxicity in zebrafish larvae

Benzalkonium chloride (BAC) is a broad-spectrum antibacterial agent that possesses cleaning and bactericidal properties, but impact of BAC on wellbeing of aquatic organisms remains uncertain. Consequently, in this current study, we have examined the immunotoxic potential of BAC in zebrafish embryos, thus marking it as the pioneering effort in this field. According to the findings, zebrafish embryos exposed to BAC exhibited a decline in yolk area that varied with the concentration, along with a significant decrease in the count of neutrophils, macrophages, red blood cells, and thymus T-cells. We observed significantly up-regulated expression of immune-related signaling genes such as cxcl-c1c, il-8, tir4 and inf-γ, but expression of nf-κb was downregulated. In addition, we observed a marked reduction in the number of hematopoietic stem cells in zebrafish larvae after BAC exposure, which could be the result of oxidative stress-mediated apoptosis. We found that compared with the control group, the number of red blood cells in juvenile zebrafish in BAC-exposure group was significantly down-regulated, which could be attributed to hematopoietic stem cell defect. Astaxanthin restored immune cells and hematopoietic stem cells after BAC exposure, whereas Inhibitor of Wnt Response-1(IWR-1) restored neutrophils after BAC exposure. The research findings demonstrated that exposure to BAC displayed harmful effects on the development and immune system of zebrafish embryos. These effects might be associated with alterations in reactive oxygen species(ROS) levels and activation of the Wnt signaling pathway caused by BAC.

Impact of urban pollution on freshwater biofilms: Oxidative stress, photosynthesis and lipid responses

Urban ecosystems are subjected to multiple anthropogenic stresses, which impact aquatic communities. Artificial light at night (ALAN) for instance can significantly alter the composition of algal communities as well as the photosynthetic cycles of autotrophic organisms, possibly leading to cellular oxidative stress. The combined effects of ALAN and chemical contamination could increase oxidative impacts in aquatic primary producers, although such combined effects remain insufficiently explored. To address this knowledge gap, a one-month experimental approach was implemented under controlled conditions to elucidate effects of ALAN and dodecylbenzyldimethylammonium chloride (DDBAC) on aquatic biofilms. DDBAC is a biocide commonly used in virucidal products, and is found in urban aquatic ecosystems. The bioaccumulation of DDBAC in biofilms exposed or not to ALAN was analyzed. The responses of taxonomic composition, photosynthetic activity, and fatty acid composition of biofilms were examined. The results indicate that ALAN negatively affects photosynthetic yield and chlorophyll production of biofilms. Additionally, exposure to DDBAC at environmental concentrations induces lipid peroxidation, with an increase of oxylipins. This experimental study provides first insights on the consequences of ALAN and DDBAC for aquatic ecosystems. It also opens avenues for the identification of new biomarkers that could be used to monitor urban pollution impacts in natural environments.

Non-Canonical Aspects of Antibiotics and Antibiotic Resistance

The understanding of antibiotic resistance, one of the major health threats of our time, is mostly based on dated and incomplete notions, especially in clinical contexts. The "canonical" mechanisms of action and pharmacodynamics of antibiotics, as well as the methods used to assess their activity upon bacteria, have not changed in decades; the same applies to the definition, acquisition, selective pressures, and drivers of resistance. As a consequence, the strategies to improve antibiotic usage and overcome resistance have ultimately failed. This review gathers most of the "non-canonical" notions on antibiotics and resistance: from the alternative mechanisms of action of antibiotics and the limitations of susceptibility testing to the wide variety of selective pressures, lateral gene transfer mechanisms, ubiquity, and societal factors maintaining resistance. Only by having a "big picture" view of the problem can adequate strategies to harness resistance be devised. These strategies must be global, addressing the many aspects that drive the increasing prevalence of resistant bacteria aside from the clinical use of antibiotics.

Effective elimination of bacteria on hard surfaces by the combined use of bacteriophages and chemical disinfectants

Hospital-acquired infections (HAIs) represent one of the significant causes of morbidity and mortality worldwide, and controlling pathogens in the hospital environment is of great importance. Currently, the standard disinfection method in the hospital environment is chemical disinfection. However, disinfectants are usually not used strictly according to the label, making them less effective in disinfection. Therefore, there is an emergent need to find a better approach that can be used in hospitals to control pathogenic bacteria in the clinical environment. Bacteriophages (phages) are effective in killing bacteria and have been applied in the treatment of bacterial infections but have not received enough attention regarding the control of contamination in the clinical environment. In this study, we found that various phages remain active in the presence of chemical disinfectants. Moreover, the combined use of specific phages and chemical disinfectants is more effective in removing bacterial biofilms and eliminating bacteria on hard surfaces. Thus, this proof-of-concept study indicates that adding phages directly to chemical disinfectants might be an effective and economical approach to enhance clinical environment disinfection.

IMPORTANCE

In this study, we investigated whether the combination of bacteriophages and chemical disinfectants can enhance the efficacy of reducing bacterial contamination on hard surfaces in the clinical setting. We found that specific phages are active in chemical disinfectants and that the combined use of phages and chemical disinfectants was highly effective in reducing bacterial presence on hard surfaces. As a proof-of-concept, we demonstrated that adding specific phages directly to chemical disinfectants is an effective and cost-efficient strategy for clinical environment disinfection.

Microplastic pollution interaction with disinfectant resistance genes: research progress, environmental impacts, and potential threats

The consumption of disposable plastic products and disinfectants has surged during the global COVID-19 pandemic, as they play a vital role in effectively preventing and controlling the spread of the virus. However, microplastic pollution and the excessive or improper use of disinfectants contribute to the increased environmental tolerance of microorganisms. Microplastics play a crucial role as vectors for microorganisms and plankton, facilitating energy transfer and horizontal gene exchange. The increase in the use of disinfectants has become a driving force for the growth of disinfectant resistant bacteria (DRB). A large number of microorganisms can have intense gene exchange, such as plasmid loss and capture, phage transduction, and cell fusion. The reproduction and diffusion rate of DRB in the environment is significantly higher than that of ordinary microorganisms, which will greatly increase the environmental tolerance of DRB. Unfortunately, there is still a huge knowledge gap in the interaction between microplastics and disinfectant resistance genes (DRGs). Accordingly, it is critical to comprehensively summarize the formation and transmission routes of DRGs on microplastics to address the problem. This paper systematically analyzed the process and mechanisms of DRGs formed by microbes. The interaction between microplastics and DRGs and the contribution of microplastic on the diffusion and spread of DRGs were expounded. The potential threats to the ecological environment and human health were also discussed. Additionally, some challenges and future priorities were also proposed with a view to providing useful basis for further research.

Performance of sewage sludge treatment for the removal of antibiotic resistance genes: Status and prospects

Wastewater treatment plants (WWTPs) receive wastewater containing antibiotic resistant bacteria (ARB) and antibiotic resistant genes (ARGs), which are predominant contributors to environmental pollution in water and soil. Of these sources, sludge is a more significant contributor than effluent. Knowing how sludge treatment affects the fate of ARGs is vital for managing the risk of these genes in both human and natural environments. This review therefore discusses the sources and transmission of ARGs in the environment and highlights the risks of ARGs in sludge. The effects of co-existing constituents (heavy metals, microplastics, etc.) on sludge and ARGs during treatment are collated to highlight the difficulty of treating sludge with complex constituents in ARGs. The effects of various sludge treatment methods on the abundances of ARGs in sludge and in soil from land application of treated sludge are discussed, pointing out that the choice of sludge treatment method should take into account various potential factors, such as soil and soil biology in subsequent land application. This review offers significant insights and explores the abundances of ARGs throughout the process of sludge treatment and disposal. Unintentional addition of antibiotic residues, heavy metals, microplastics and organic matter in sludge could significantly increase the abundance and reduce the removal efficiency of ARGs during treatment, which undoubtedly adds a barrier to the removal of ARGs from sludge treatment. The complexity of the sludge composition and the diversities of ARGs have led to the fact that no effective sludge treatment method has so far been able to completely eliminate the ecological risk of ARGs. In order to reduce risks resulting by transmission of ARGs, technical and management measures need to be implemented.

Exploiting genomics for antimicrobial resistance surveillance at One Health interfaces

The intersection of human, animal, and ecosystem health at One Health interfaces is recognised as being of key importance in the evolution and spread of antimicrobial resistance (AMR) and represents an important, and yet rarely realised opportunity to undertake vital AMR surveillance. A working group of international experts in pathogen genomics, AMR, and One Health convened to take part in a workshop series and online consultation focused on the opportunities and challenges facing genomic AMR surveillance in a range of settings. Here we outline the working group's discussion of the potential utility, advantages of, and barriers to, the implementation of genomic AMR surveillance at One Health interfaces and propose a series of recommendations for addressing these challenges. Embedding AMR surveillance at One Health interfaces will require the development of clear beneficial use cases, especially in low-income and middle-income countries. Evidence of directionality, risks to human and animal health, and potential trade implications were also identified by the working group as key issues. Addressing these challenges will be vital to enable genomic surveillance technology to reach its full potential for assessing the risk of transmission of AMR between the environment, animals, and humans at One Health interfaces.

Risks of benzalkonium chlorides as emerging contaminants in the environment and possible control strategies from the perspective of ecopharmacovigilance

An unprecedented increase in the use of disinfection products triggered by the coronavirus disease 2019 (COVID-19) pandemic is resulting in aggravating environmental loads of disinfectants as emerging contaminants, which has been considered a cause for worldwide secondary disasters. This review analyzed the literature published in the last decade about occurrence, bioaccumulation, and possible environmental risks of benzalkonium chlorides (BKCs) as emerging contaminants. Results indicated that BKCs globally occurred in municipal wastewater, surface water, groundwater, reclaimed water, sludge, sediment, soil, roof runoff, and residential dust samples across 13 countries. The maximum residual levels of 30 mg/L and 421 μg/g were reported in water and solid environmental samples, respectively. Emerging evidences suggested possible bioaccumulation of BKCs in plants, even perhaps humans. Environmentally relevant concentrations of BKCs exert potential adverse impacts on aquatic and terrestrial species, including genotoxicity, respiratory toxicity, behavioural effects and neurotoxicity, endocrine disruption and reproductive impairment, phytotoxicity, etc. Given the intrinsic biocidal and preservative properties of disinfectants, the inductive effects of residual BKCs in environment in terms of resistance and imbalance of microorganisms have been paid special attention. Considering the similarities of disinfectants to pharmaceuticals, from the perspective of ecopharmacovigilance (EPV), a well-established strategy for pharmaceutical emerging contaminants, we use the control of BKC pollution as a case, and provide some recommendations for employing the EPV measures to manage environmental risks posed by disinfectant emerging contaminants.

Chlorine disinfection modifies the microbiome, resistome and mobilome of hospital wastewater - A nanopore long-read metagenomic approach

The aim of the present study was to analyze changes in the microbiome, resistome, and mobilome of hospital wastewater (HWW) induced by disinfection with chlorine compounds. Changes in bacterial communities and specific antibiotic resistance genes (ARGs) in HWW were determined with the use of a nanopore long-read metagenomic approach. The main hosts of ARGs in HWW were identified, and the mobility of resistance mechanisms was analyzed. Special attention was paid to the prevalence of critical-priority pathogens in the HWW microbiome, which pose the greatest threat to human health. The results of this study indicate that chlorine disinfection of HWW can induce significant changes in the structure of the total bacterial population and antibiotic resistant bacteria (ARB) communities, and that it can modify the resistome and mobilome of HWW. Disinfection favored the selection of ARGs, decreased their prevalence in HWW, while increasing their diversity. The mobility of the HWW resistome increased after disinfection. Disinfection led to the emergence of new drug resistance mechanisms in previously sensitive bacterial taxa. In conclusion, this study demonstrated that HWW disinfected with low (sublethal) concentrations of free chlorine significantly contributes to the mobility and transfer of drug resistance mechanisms (including critical mechanisms) between bacteria (including pathogens).

Stochastic Dynamic Mass Spectrometric Quantitative and Structural Analyses of Pharmaceutics and Biocides in Biota and Sewage Sludge

Mass spectrometric innovations in analytical instrumentation tend to be accompanied by the development of a data-processing methodology, expecting to gain molecular-level insights into real-life objects. Qualitative and semi-quantitative methods have been replaced routinely by precise, accurate, selective, and sensitive quantitative ones. Currently, mass spectrometric 3D molecular structural methods are attractive. As an attempt to establish a reliable link between quantitative and 3D structural analyses, there has been developed an innovative formula [DSD″,tot=∑inDSD″,i=∑in2.6388.10-17×Ii2¯-Ii¯2] capable of the exact determination of the analyte amount and its 3D structure. It processed, herein, ultra-high resolution mass spectrometric variables of paracetamol, atenolol, propranolol, and benzalkonium chlorides in biota, using mussel tissue and sewage sludge. Quantum chemistry and chemometrics were also used. Results: Data on mixtures of antibiotics and surfactants in biota and the linear dynamic range of concentrations 2-80 ng.(mL)-1 and collision energy CE = 5-60 V are provided. Quantitative analysis of surfactants in biota via calibration equation ln[D″SD] = f(conc.) yields the exact parameter |r| = 0.99991, examining the peaks of BAC-C12 at m/z 212.209 ± 0.1 and 211.75 ± 0.15 for tautomers of fragmentation ions. Exact parameter |r| = 1 has been obtained, correlating the theory and experiments in determining the 3D molecular structures of ions of paracetamol at m/z 152, 158, 174, 301, and 325 in biota.