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

Litopeidin28-51, a novel antimicrobial peptide from Litopenaeus vannamei, combats white spot syndrome virus infection through direct virus lysis and immunomodulatory effects

White spot syndrome virus (WSSV) poses a critical threat to crustacean aquaculture, particularly shrimp, causing widespread pandemics. In crustaceans, hemocytes function as a key component of the innate immune system and play a pivotal role in both cellular and humoral immune responses by producing various immune factors, such as antimicrobial peptides (AMPs), to defend against pathogenic microorganisms. In this study, an uncharacterized functional gene named Litopeidin was identified in Pacific white shrimp (Litopenaeus vannamei). It exhibited heightened expression in hemocytes and demonstrated a significant response to WSSV infection. Further, a truncated peptide, Litopeidin28-51, derived from this gene, was characterized and identified as a novel AMP with robust antibacterial and antifungal properties, especially against common aquatic pathogens, including Vibrio spp. Moreover, Litopeidin28-51 significantly suppressed the expression of viral genes (IE1 and VP28, WSSV replication-related genes) and the VP28 protein, as well as reduced viral copy numbers in hematopoietic tissue (Hpt) cells following WSSV infection. Mechanistic studies revealed that Litopeidin28-51 exhibited a direct virucidal effect on WSSV and significantly upregulated immune-related gene expression (including Relish, ALF, Crustin, and LYZ1) in Hpt cells. Notably, in Cherax quadricarinatus and L. vannamei, either co- or pre-treatment with Litopeidin28-51 markedly reduced animal mortality and viral replication in tissues. Collectively, the findings suggest that Litopeidin28-51, a newly identified AMP with potent antibacterial activity, effectively inhibits WSSV replication by disrupting the viral envelope and regulating the cellular antiviral responses, making it a promising candidate for developing anti-infective agents or immunostimulants in aquaculture.

- Invited Review - Challenges and constraints to the sustainability of poultry farming in Thailand

The poultry farming industry in Thailand plays a crucial role in the nation's economy and food security. However, its long-term sustainability is challenged by disease outbreaks, environmental concerns, rising feed costs, market fluctuations, and shifting consumer preferences. This review examines the current state of poultry farming in Thailand, focusing on broilers, layers, and ducks. Disease control requires strict biosecurity measures and government interventions. Additionally, the industry must address environmental concerns by reducing greenhouse gas emissions and optimizing resource efficiency to align with Thailand's net-zero targets. The rising demand for organic and ethically produced poultry products presents both market opportunities and production challenges, necessitating significant adjustments in farming practices. Regulatory compliance, particularly in export markets, adds another layer of complexity, requiring Thai poultry producers to meet increasingly stringent international standards. The adoption of new technologies, such as precision farming and artificial intelligence-driven systems, presents both opportunities and challenges, especially for smaller producers who may struggle to keep pace with advancements. Rising feed costs, driven by global supply chain disruptions and dependence on imported raw materials, pose a significant economic burden, emphasizing the need for alternative protein sources such as insect-based feed and agro-industrial by-products. Furthermore, regulatory compliance with international standards and consumer-driven trends toward antibiotic-free and organic poultry products further shape the industry's transformation. To ensure sustainable development, Thailand's poultry sector must integrate innovative technologies, adopt environmentally friendly practices, and strengthen collaboration between the government, industry stakeholders, and researchers. The industry can maintain its global competitiveness by addressing these challenges while contributing to sustainable food production and environmental conservation.

Antimicrobial risk assessment-Aggregating aquatic chemical and resistome emissions

Urban water systems receive and emit antimicrobial chemicals, resistant bacterial strains, and resistance genes (ARGs), thus representing "antimicrobial hotspots". Currently, regional environmental risk assessment (ERA) is carried out using drug consumption data and threshold concentrations derived based on chemical-specific minimum inhibitory concentration values. A legislative proposal by the European Commission released in 2022 addresses the need to include selected ARGs besides the chemical concentration-based ERAs. The questions arise as to (A) how to improve chemical concentration-based risk assessment and (B) how to integrate resistome-related information with chemical-based risk - the main focal areas of this study. A tiered chemical risk prediction method is proposed by considering effluents of sewer networks and water resource recovery facilities (WRRFs). To improve predicted environmental concentrations (PEC in recipient water bodies), the impact of antimicrobial bio- and re-transformation in WRRFs is assessed using reliable global data. To combine chemical and genetic risks, a new parameter, i.e., the gene response efficiency (GRE) is proposed. A regression analysis show four orders of magnitude differences in GRE values amongst the seven antimicrobial classes studied. Higher GRE values in wastewater are obtained for antimicrobials with relatively low consumption rate levels.

Insights into antibiotic resistance promoted by quinolone exposure

Quinolone-induced antibiotic resistance (QIAR) refers to the phenomenon by which bacteria exposed to sublethal levels of quinolones acquire resistance to non-quinolone antibiotics. We have explored this in Escherichia coli MG1655 using a variety of compounds and bacteria carrying a quinolone-resistance mutation in gyrase, mutations affecting the SOS response, and mutations in error-prone polymerases. The nature of the antibiotic-resistance mutations was determined by whole-genome sequencing. Exposure to low levels of most quinolones tested led to mutations conferring resistance to chloramphenicol, ampicillin, kanamycin, and tetracycline. The mutations included point mutations and deletions and could mostly be correlated with the resistance phenotype. QIAR depended upon DNA gyrase and involved the SOS response but was not dependent on error-prone polymerases. Only moxifloxacin, among the quinolones tested, did not display a significant QIAR effect. We speculate that the lack of QIAR with moxifloxacin may be attributable to it acting via a different mechanism. In addition to the concerns about antimicrobial resistance to quinolones and other compounds, QIAR presents an additional challenge in relation to the usage of quinolone antibacterials.

Presence of emerging organic contaminants and microbial indicators in surface water and groundwater in urban India

This study presents a first combined assessment of emerging organic contaminants (EOC) and antimicrobial resistance (AMR) indicators in the South Indian city of Bengaluru from multiple sources, addressing a knowledge gap on EOCs and AMR occurrences and relationships in different water sources in urban India. A unique approach in this study was to combine the detection of EOCs with an assessment of the AMR-indicating class 1 integron-integrase gene, intI1. Twenty-five samples collected from groundwater, local surface waters, and tap water imported from the Cauvery Basin were screened for 1499 EOCs. A total of 125 EOCs were detected at concentrations per compound of up to 314 μg/L. Concentrations for a range of contaminants were higher than those previously detected in Indian groundwaters. High concentrations of Per- and polyfluoroalkyl substances (PFAS) were detected with up to 1.8 μg/L in surface water and up to 0.9 μg/L in groundwater. Calculated risk quotients indicated potential AMR development caused by high concentrations of azithromycin, fluconazole, and sulfanilamide in surface waters that have little protection against sewage inflows. Surface waters that have recently undergone environmental restoration (e.g., removing silted bottom layers and enhancing protection against encroachments and sewage inflows) had lower EOC detections and risk of AMR development. Specific EOC detections, e.g., the ubiquitous detection of the sweetener sucralose (in use since ∼2000), indicated recent groundwater recharge and a contribution of imported Cauvery River water for recharge. This study highlights the need for monitoring and water protection, the role of EOCs as potential drivers of AMR, and the success of surface water protection measures to improve freshwater quality.

Do storm overflows influence AMR in the environment and is this relevant to human health? A UK perspective on a global issue

Antimicrobial resistance (AMR) is a global public health threat, and the environment has been identified as an important reservoir for resistant microorganisms and genes. Storm overflows (SOs) discharge wastewater and stormwater, and are found throughout many wastewater networks. While there are no data currently showing the impact of SOs on the environment with respect to AMR in the UK, there is a small but growing body of evidence globally highlighting the potential role of SOs on environmental AMR. This review aims to provide an overview of the current state of SOs, describe global data investigating the impact of SOs on environmental AMR, and discuss the implications of SOs regarding AMR and human health. In addition, the complexities of studying the effects of SOs are discussed and a set of priority research questions and policy interventions to tackle a potentially emerging threat to public health are presented.

Occurrence and dissemination of antibiotics and antibiotic resistance in aquatic environment and its ecological implications: a review

The occurrence of antibiotics and antibiotic-resistant bacteria (ARBs), genes (ARGs), and mobile genetic elements (MGEs) in aquatic systems is growing global public health concern. These emerging micropollutants, stemming from improper wastewater treatment and disposal, highlight the complex and evolving nature of environmental pollution. Current literature reveals potential biases, such as a geographical focus on specific regions, leading to an insufficient understanding of the global distribution and dynamics of antibiotic resistance in aquatic systems. There is methodological inconsistency across studies, making it challenging to compare findings. Potential biases include sample collection inconsistencies, detection sensitivity variances, and data interpretation variability. Gaps in understanding include the need for comprehensive, standardized long-term monitoring programs, elucidating the environmental fate and transformation of antibiotics and resistance genes. This review summarizes current knowledge on the occurrence and dissemination of emerging micropollutants, their ecological impacts, and the global health implications of antimicrobial resistance. It highlights the need for interdisciplinary collaborations among researchers, policymakers, and stakeholders to address the challenges posed by antibiotic resistance in aquatic resistance in aquatic systems effectively. This review highlights widespread antibiotic and antibiotic resistance in aquatic environment, driven by human and agricultural activities. It underscores the ecological consequences, including disrupted microbial communities and altered ecosystem functions. The findings call for urgent measures to mitigate antibiotics pollution and manage antibiotic resistance spread in water bodies.

Does Environmental Exposure to Pharmaceutical and Personal Care Product Residues Result in the Selection of Antimicrobial-Resistant Microorganisms, and is this Important in Terms of Human Health Outcomes?

The environment plays a critical role in the development, dissemination, and transmission of antimicrobial resistance (AMR). Pharmaceuticals and personal care products (PPCPs) enter the environment through direct application to the environment and through anthropogenic pollution. Although there is a growing body of evidence defining minimal selective concentrations (MSCs) of antibiotics and the role antibiotics play in horizontal gene transfer (HGT), there is limited evidence on the role of non-antibiotic PPCPs. Existing data show associations with the development of resistance or effects on bacterial growth rather than calculating selective endpoints. Research has focused on laboratory-based systems rather than in situ experiments, although PPCP concentrations found throughout wastewater, natural water, and soil environments are often within the range of laboratory-derived MSCs and at concentrations shown to promote HGT. Increased selection and HGT of AMR by PPCPs will result in an increase in total AMR abundance in the environment, increasing the risk of exposure and potential transmission of environmental AMR to humans. There is some evidence to suggest that humans can acquire resistance from environmental settings, with water environments being the most frequently studied. However, because this is currently limited, we recommend that more evidence be gathered to understand the risk the environment plays in regard to human health. In addition, we recommend that future research efforts focus on MSC-based experiments for non-antibiotic PPCPS, particularly in situ, and investigate the effect of PPCP mixtures on AMR. Environ Toxicol Chem 2024;43:623-636. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Water, Water Everywhere, but Every Drop Unique: Challenges in the Science to Understand the Role of Contaminants of Emerging Concern in the Management of Drinking Water Supplies

The protection and management of water resources continues to be challenged by multiple and ongoing factors such as shifts in demographic, social, economic, and public health requirements. Physical limitations placed on access to potable supplies include natural and human-caused factors such as aquifer depletion, aging infrastructure, saltwater intrusion, floods, and drought. These factors, although varying in magnitude, spatial extent, and timing, can exacerbate the potential for contaminants of concern (CECs) to be present in sources of drinking water, infrastructure, premise plumbing and associated tap water. This monograph examines how current and emerging scientific efforts and technologies increase our understanding of the range of CECs and drinking water issues facing current and future populations. It is not intended to be read in one sitting, but is instead a starting point for scientists wanting to learn more about the issues surrounding CECs. This text discusses the topical evolution CECs over time (Section 1), improvements in measuring chemical and microbial CECs, through both analysis of concentration and toxicity (Section 2) and modeling CEC exposure and fate (Section 3), forms of treatment effective at removing chemical and microbial CECs (Section 4), and potential for human health impacts from exposure to CECs (Section 5). The paper concludes with how changes to water quantity, both scarcity and surpluses, could affect water quality (Section 6). Taken together, these sections document the past 25 years of CEC research and the regulatory response to these contaminants, the current work to identify and monitor CECs and mitigate exposure, and the challenges facing the future.

Preslaughter handling factors affecting dead on arrival, condemnations, and bruising in broiler chickens raised without an antibiotic program

In Thailand, knowledge about the factors affecting broiler losses during the preslaughter process is very limited, especially for broilers raised without an antibiotic program. The objective of this study was to determine the preslaughter factors that influence the incidence of dead on arrival (DOA), condemnations, and bruising in broilers raised without antibiotics. Data from 13,581 truckloads of broilers raised without an antibiotic program in 95 contract farms of one of Thailand's largest broiler producers in 2021 were analyzed using a generalized linear mixed model that accounted for farm as a random effect. Results showed that the following risk factors were associated with the occurrence of DOA, condemnations, and bruising: season, time of transport, sex, age at slaughter, mortality and culling rate, and weight per crate. While mean body weight affected the incidence of condemnations and bruising, transport time and lairage time affected DOA and bruising. Feed withdrawal time affected DOA and condemnations. Rearing stocking density only affected condemnation rate. Reducing or eliminating the effects of these risk factors could reduce production losses due to DOA, condemnations, and bruising, thereby improving animal welfare and producer profitability. Reducing weight per crate could reduce DOA, condemnations, and bruising. Reducing lairage time could reduce DOA and bruising, while reducing feed withdrawal time could reduce DOA and condemnations. Raising broilers at a younger age with a lower slaughter weight could prevent the occurrence of DOA, condemnations, and bruising.

Risk ranking of macrolide antibiotics - Release levels, resistance formation potential and ecological risk

Antibiotic resistance (AR) development in natural water bodies is a significant source of concern. Macrolide antibiotics in particular have been identified as pollutants of concern for AR development throughout the literature, as well as by state and international authorities. This study utilises a probabilistic model to examine the risk of AR development arising from human-use macrolide residues, utilising administration rates from Ireland as a case study. Stages modelled included level of administration, excretion, degradation in wastewater, removal in wastewater treatment, assuming conventional activated sludge (CAS) treatment, and dilution. Release estimates per day, as well as risk quotient values for antibiotic resistance development and ecological impact, are generated for erythromycin, clarithromycin, and azithromycin. In the modelled scenario in which conventional activated sludge treatment is utilised in wastewater treatment, this model ranks risk of resistance development for each antibiotic in the order clarithromycin > azithromycin > erythromycin, with mean risk quotient values of 0.50, 0.34 and 0.12, respectively. A membrane bioreactor scenario was also modelled, which reduced risk quotient values for all three macrolides by at least 50 %. Risk of ecological impact for each antibiotic was also examined, by comparing environmental concentrations predicted to safety limits based on toxicity data for cyanobacteria and other organisms from the literature, with azithromycin being identified as the macrolide of highest risk. This study compares and quantifies the risk of resistance development and ecological impact for a high-risk antibiotic group in the Irish context, and demonstrates the potential for risk reduction achieved by adoption of alternative (e.g. membrane bioreactor) technology.

Immunostimulants for shrimp aquaculture: paving pathway towards shrimp sustainability

At present, food security is a matter of debate of global magnitude and fulfilling the feeding requirement of > 8 billion human populations by 2030 is one of the major concerns of the globe. Aquaculture plays a significant role to meet the global food requirement. Shrimp species such as Litopenaeus vannamei, Penaeus monodon, and Macrobrachium rosenbergii are among the most popular food commodities worldwide. As per Global Outlook for Aquaculture Leadership survey, disease outbreaks have been a matter of concern from the past many decades regarding the shrimp aquaculture production. Among the past disease outbreaks, white spot disease caused by the white spot syndrome virus is considered to be one of the most devastating ones that caused colossal losses to the shrimp industry. Since the virus is highly contagious, it spreads gregariously among the shrimp population; hence, practicing proper sanitization practices is crucial in order to have disease-free shrimps. Additionally, in order to control the disease, antibiotics were used that further leads to bioaccumulation and biomagnification of antibiotics in several food webs. The bioaccumulation of the toxic residues in the food webs further adversely affected human too. Recently, immunostimulants/antivirals were used as an alternative to antibiotics. They were found to enhance the immune system of shrimps in eco-friendly manner. In context to this, the present paper presents a critical review on the immunostimulants available from plants, animals, and chemicals against WSSV in shrimps. Looking into this scenario, maintaining proper sanitation procedures in conjunction with the employment of immunostimulants may be a viable approach for preserving shrimp aquaculture across the globe.

Insights into antibiotic stewardship of lake-rivers-basin complex systems for resistance risk control

Antibiotic stewardship is hindered by a lack of consideration for complicated environmental fate of antibiotics and their role in resistance development, while the current methodology of eco-toxicological risk assessment has not been fully protective against their potential to select for antibiotic resistance. To address this problem, we established a novel methodologic framework to perform comprehensive environmental risk assessment of antibiotics in terms of resistance development, which was based on selection effect, phenotype resistance level, heteroresistance frequency, as well as prevalence and stability of antibiotic resistance genes. We tracked the contribution of antibiotic load reduction to the mitigation of environmental risk of resistance development by fate and transport modeling. The method was instantiated in a lake-river network-basin complex system, taking the Taihu Basin as a case study. Overall, antibiotic load posed no eco-toxicological risk but an average medium-level environmental risk for resistance development in Taihu Lake. The effect of antibiotic load on resistance risk was both seasonal-dependent and category-dependent, while quinolones posed the greatest environmental risk for resistance development. Mass-flow analysis indicated that temporal-spatial variation in hydrological regime and antibiotic fate together exerted a significant effect on antibiotic load in the system. By apportioning antibiotic load to riverine influx, we identified the hotspots for load reduction and predicted the beneficial response of resistance risk under load-reduction scenarios. Our study proposed a risk-oriented strategy of basin-scaled antibiotic load reduction for environmental risk control of resistance development.

A comparative risk ranking of antibiotic pollution from human and veterinary antibiotic usage - An Irish case study

Antibiotic use in the healthcare and agriculture sectors has resulted in levels being found in environmental compartments including surface waters. This can create a selective pressure toward antibiotic resistance development, representing a potential risk to human health. Examining the Irish scenario, this screening paper develops a novel risk ranking model to comparatively assess, on a national scale, the predicted amount of antibiotics entering water bodies as a result of their use in healthcare and agricultural sectors, and the subsequent risk of antibiotic resistance development. Probabilistic modelling approaches, based on data sourced from published literature on antibiotics, are used to account for inherent uncertainty and variability in the input factors; usage, metabolism, degradation and wastewater removal rates, estimating the mass of six antibiotic classes released daily from both sectors. These mass estimates are used to generate predicted concentrations and risk quotient values for each drug class, utilising estimated minimum inhibitory concentration values sourced from the literature. Modelled results predict higher risk quotient (RQ) values in the healthcare compared to agriculture sector, with macrolides and penicillins ranking highest in terms of RQ value. A lower RQ is also predicted from human-use tetracyclines, trimethoprim, and quinolones. Avenues for runoff reduction for each antibiotic class, in particular the higher-risk classes, in both usage sectors are discussed. For validation, predicted levels are compared to observed levels of antibiotic residues in Ireland. Key knowledge gaps to assist prediction and modelling of antibiotic pollution in future studies are also discussed. This research paper establishes a protocol and model structure, applicable to other regions, to compare the contributions of healthcare and agriculture to antibiotic pollution, and identifies highest-ranked antibiotic classes in terms of potential resistance development for prioritisation in the Irish situation.

Antimicrobial Resistance in Rivers: A Review of the Genes Detected and New Challenges

River ecosystems are very important parts of the water cycle and an excellent habitat, food, and drinking water source for many organisms, including humans. Antibiotics are emerging contaminants which can enter rivers from various sources. Several antibiotics and their related antibiotic resistance genes (ARGs) have been detected in these ecosystems by various research programs and could constitute a substantial problem. The presence of antibiotics and other resistance cofactors can boost the development of ARGs in the chromosomes or mobile genetic elements of natural bacteria in rivers. The ARGs in environmental bacteria can also be transferred to clinically important pathogens. However, antibiotics and their resistance genes are both not currently monitored by national or international authorities responsible for controlling the quality of water bodies. For example, they are not included in the contaminant list in the European Water Framework Directive or in the US list of Water-Quality Benchmarks for Contaminants. Although ARGs are naturally present in the environment, very few studies have focused on non-impacted rivers to assess the background ARG levels in rivers, which could provide some useful indications for future environmental regulation and legislation. The present study reviews the antibiotics and associated ARGs most commonly measured and detected in rivers, including the primary analysis tools used for their assessment. In addition, other factors that could enhance antibiotic resistance, such as the effects of chemical mixtures, the effects of climate change, and the potential effects of the coronavirus disease 2019 pandemic, are discussed. Environ Toxicol Chem 2022;41:687-714. © 2022 SETAC.

PrAna: an R package to calculate and visualize England NHS primary care prescribing data

Background

The objective of this work to calculate prescribed quantity of an active pharmaceutical ingredient (API) in prescription medications for human use, to facilitate research on the prediction of amount of API released to the environment and create an open-data tool to facilitate spatiotemporal and long-term prescription trends for wider usage.

Design

We have developed an R package, PrAna to calculate the prescribed quantity (in kg) of an APIs by postcode using England’s national level prescription data provided by National Health Service, for the years 2015–2018. Datasets generated using PrAna can be visualized in a real-time interactive web-based tool, PrAnaViz to explore spatiotemporal and long-term trends. The visualisations can be customised by selecting month, year, API, and region.

Results

PrAnaViz’s targeted API approach is demonstrated with the visualisation of prescribed quantities of 14 APIs in the Bath and North East Somerset (BANES) region during 2018. Once the APIs list is loaded, the back end retrieves relevant data and populates the graphs based on user-defined data features in real-time. These plots include the prescribed quantity of APIs over a year, by month, and individual API by month, general practice, postcode, and medicinal form. The non-targeted API approach is demonstrated with the visualisation of clarithromycin prescribed quantities at different postcodes in the BANES region.

Conclusion

PrAna and PrAnaViz enables the analysis of spatio-temporal and long-term trends with prescribed quantities of different APIs by postcode. This can be used as a support tool for policymakers, academics and researchers in public healthcare, and environmental scientist to monitor different group of pharmaceuticals emitted to the environment and for prospective risk assessment of pharmaceuticals in the environment.

Quantifying the Gap between Expected and Actual Rates of Antibiotic Prescribing in British Columbia, Canada

Despite decades of stewardship efforts to combat antimicrobial resistance and quantify changes in use, the quality of antibiotic use in British Columbia (BC) remains unknown. As the overuse and misuse of antibiotics drives antibiotic resistance, it is imperative to expand surveillance efforts to examine the quality of antibiotic prescriptions. In late 2019, Canadian expected rates of antibiotic prescribing were developed for common infections. These rates were utilized to quantify the gap between the observed rates of prescribing and Canadian expected rates for antibiotic use for the province of BC. The prescribing data were extracted and matched to physician billing systems using anonymized patient identifiers from 1 January 2000 to 31 December 2018. Outpatient prescribing was further subdivided into community and emergency department settings and stratified by the following age groups: <2 years, 2-18 years, and ≥19 years. The proportions of physician visits that received antibiotic prescription were compared against the Canadian expected rates to quantify the unnecessary use for 18 common indications. Respiratory tract infections (RTI), including acute bronchitis, acute sinusitis, and acute pharyngitis, reported significant levels of overprescribing. Across all ages and health care settings, prescribing for RTI indications occurred at rates 2-8 times higher than the expected rates recommended by a group of expert Canadian physicians. Understanding the magnitude of unnecessary prescribing is a first step in delineating the provincial prescribing quality. The quantification of antibiotic overuse offers concrete targets for provincial stewardship efforts to reduce unnecessary prescribing by an average of 30% across both outpatient and emergency care settings.

Persisting antibiotic resistance gene pollution and its association with human sewage sources in tropical marine beach waters

Antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) are pollutants of worldwide concern that threaten human health and ecosystems. Anthropogenic activities and wastewater could be ARB and ARG pollution sources; however, research on ARG abundance and microbial source tracking (MST) of contamination in tropical marine waters is limited. This study examined spatiotemporal variations of six ARGs (bla_NDM, bla_TEM, bla_VIM, mcr-1, sul1, and tetQ) against the widely used antibiotic groups and a class 1 integron-integrase gene (intI1) at two Thai tropical recreational beaches (n = 41). Correlations between ARGs and sewage-specific MST markers (i.e., crAssphage and human polyomaviruses [HPyVs]) and fecal indicator bacteria (i.e., total coliforms, fecal coliforms, and enterococci) were also investigated. Bla_TEM, intI1, sul1, and tetQ were ubiquitous at both beaches (85.4-100% detection rate); intI1 was the most abundant (3-6 orders in log₁₀ copies/100 mL), followed by bla_TEM (2-4 orders), sul1 (2-3 orders), and tetQ (2-4 orders). Bla_NDM was found in 7.3% (up to 4 orders), and no mcr-1 was detected. Interestingly, bla_VIM was prevalent at one beach (2-5 orders; n = 17), but found in only one sample at the other (4 orders). Temporal, but not spatial, differences were noticed; bla_TEM was at higher levels in the wet season. IntI1 correlated with sul1 and tetQ (Spearman's rho = 0.47-0.97), suggesting potential horizontal gene transfer. CrAssphage, but not HPyVs, correlated with intI1, sul1, and tetQ (Spearman's rho = 0.50-0.74). Higher numbers of ARGs tended to co-occur in samples with higher crAssphage concentrations, implying sewage contribution to the marine water, with a persisting ARG background. This study provides insight into the ARG pollution status of tropical coastal waters and suggests crAssphage as a proxy for ARG pollution, which could facilitate effective management policies to minimize ARG dissemination in marine environments.

Quantifying and predicting antimicrobials and antimicrobial resistance genes in waterbodies through a holistic approach: a study in Minnesota, United States

The environment plays a key role in the spread and persistence of antimicrobial resistance (AMR). Antimicrobials and antimicrobial resistance genes (ARG) are released into the environment from sources such as wastewater treatment plants, and animal farms. This study describes an approach guided by spatial mapping to quantify and predict antimicrobials and ARG in Minnesota’s waterbodies in water and sediment at two spatial scales: macro, throughout the state, and micro, in specific waterbodies. At the macroscale, the highest concentrations across all antimicrobial classes were found near populated areas. Kernel interpolation provided an approximation of antimicrobial concentrations and ARG abundance at unsampled locations. However, there was high uncertainty in these predictions, due in part to low study power and large distances between sites. At the microscale, wastewater treatment plants had an effect on ARG abundance (sul1 and sul2 in water; bla_SHV, intl1, mexB, and sul2 in sediment), but not on antimicrobial concentrations. Results from sediment reflected a long-term history, while water reflected a more transient record of antimicrobials and ARG. This study highlights the value of using spatial analyses, different spatial scales, and sampling matrices, to design an environmental monitoring approach to advance our understanding of AMR persistence and dissemination.

The relationship among corporate social responsibility, sustainability and organizational performance in pharmaceutical sector: a literature review

Purpose

This study aims to review the extant literature in pharmaceutical sector on corporate social responsibility (CSR), sustainability and organizational performance to explore if a relationship exists among these three elements.

Design/methodology/approach

A total of 301 research articles were collected from online databases. A new ECG framework representing environment, community and growth was used to classify the collected literature under the three elements: CSR, sustainability and organizational performance.

Findings

Key findings under the identified categories are: A) Environment: Strict legislation and green chemistry have revolutionized the pharmaceutical sector by decreasing manufacturing costs, minimizing the environmental footprint and improving compliance with regulations. B) Community: Community goodwill and organization’s image have gained importance under the influence of external and internal stakeholders. C) Growth: A weak relationship exists between CSR and organizational performance but increases engagement in sustainability practices which has led to increased market performance. Effective integration of social and environmental goals with strategic business processes could result in long-term profits.

Originality/value

This study focuses on the extant literature to identify the significance of CSR and sustainability on the organizational performance of the pharmaceutical sector. The propositions developed in this study will help in identifying the interdependency of the aforementioned three elements opening further possibilities of in-depth sector specific studies.

Beyond Antimicrobial Use: A Framework for Prioritizing Antimicrobial Resistance Interventions

Antimicrobial resistance (AMR) is a threat to animal and human health. Antimicrobial use has been identified as a major driver of AMR, and reductions in use are a focal point of interventions to reduce resistance. Accordingly, stakeholders in human health and livestock production have implemented antimicrobial stewardship programs aimed at reducing use. Thus far, these efforts have yielded variable impacts on AMR. Furthermore, scientific advances are prompting an expansion and more nuanced appreciation of the many nonantibiotic factors that drive AMR, as well as how these factors vary across systems, geographies, and contexts. Given these trends, we propose a framework to prioritize AMR interventions. We use this framework to evaluate the impact of interventions that focus on antimicrobial use. We conclude by suggesting that priorities be expanded to include greater consideration of host-microbial interactions that dictate AMR, as well as anthropogenic and environmental systems that promote dissemination of AMR.

Antibiotic residues in the aquatic environment - current perspective and risk considerations

Antimicrobial resistance is a major concern for human and animal health, projected to deteriorate with time and given current trends of antimicrobial usage. Antimicrobial use, particularly in healthcare and agriculture, can result in the release of antimicrobials into surface waters, promoting the development of antibiotic resistance in the environment, and potentially leading to human health risks. This study reviews relevant literature, and investigates current European and Irish antimicrobial usage trends in humans and animals, as well as potential pathways that antibiotics can take into surface waters following use. Reported levels in the aquatic environment are summarized, with particular focus on Ireland. There are relatively few studies examining Irish water bodies or sewage effluent for antibiotic residues, however, five antibiotics, namely azithromycin, ciprofloxacin, clarithromycin, metronidazole, and trimethoprim, have been measured in Irish waters, in concentrations predicted to select for resistance. Numerous isolates of multi-drug resistant bacteria have also been found in water bodies throughout Ireland and Europe. The value of risk assessment methodologies in understanding risks posed by antibiotic residues is reviewed including the advantages and disadvantages of specific approaches. Hazard quotient and bespoke Monte Carlo approaches are predominant risk assessment tools used to examine antimicrobial release and their complex pathways. This study highlights the need for monitoring of antimicrobial releases and the potential for resistance development, persistence and transmission while highlighting the role of risk assessment methodologies in assessing potential human and environmental health impacts.

Submarine groundwater discharge: A previously undocumented source of contaminants of emerging concern to the coastal ocean (Sydney, Australia)

Submarine groundwater discharge (SGD) is rarely considered as a pathway for contaminants of emerging concern (CECs). Here, we investigated SGD as a source of CECs in Sydney Harbour, Australia. CEC detection frequencies based on presence/absence of a specific compound were >90% for caffeine, carbamazepine, and dioxins, and overall ranged from 25 to 100% in five studied embayments. SGD rates estimated from radium isotopes explained >80% of observed CEC inventories for one or more compounds (caffeine, carbamazepine, dioxins, sulfamethoxazole, fluoroquinolones and ibuprofen) in four out of the five embayments. Radium-derived residence times imply mixing is also an important process for driving coastal inventories of these persistent chemicals. Two compounds (ibuprofen and dioxins) were in concentrations deemed a high risk to the ecosystem. Overall, we demonstrate that SGD can act as a vector for CECs negatively impacting coastal water quality.

Occurrence and toxicity of antibiotics in the aquatic environment: A review

In recent years, antibiotics have been used for human and animal disease treatment, growth promotion, and prophylaxis, and their consumption is rising worldwide. Antibiotics are often not fully metabolized by the body and are released into the aquatic environment, where they may have negative effects on the non-target species. This review examines the recent researches on eight representative antibiotics (erythromycin, trimethoprim, sulfamethoxazole, tetracycline, oxytetracycline, ofloxacin, ciprofloxacin, and amoxicillin). A detailed overview of their concentrations in surface waters, groundwater, and effluents is provided, supported by recent global human consumption and veterinary use data. Furthermore, we review the ecotoxicity of these antibiotics towards different groups of organisms, and assessment of the environmental risks to aquatic organisms. This review discusses and compares the suitability of currently used ecotoxicological bioassays, and identifies the knowledge gaps and future challenges. The risk data indicate that selected antibiotics may pose a threat to aquatic environments. Cyanobacteria were the most sensitive organisms when using standard ecotoxicological bioassays. Further studies on their chronic effects to aquatic organisms and the toxicity of antibiotic mixtures are necessary to fully understand the hazards these antibiotics present.

Chinese physicians' attitudes toward eco-directed sustainable prescribing from the perspective of ecopharmacovigilance: a cross-sectional study

INTRODUCTION

Eco-directed sustainable prescribing (EDSP) is an effective upstream way to reduce the environmental footprints of active pharmaceutical ingredients (APIs), a kind of emerging contaminants, from the patients' excretion. EDSP is one of the key steps in the programme of ecopharmacovigilance (EPV), a drug administration route on API pollution.

OBJECTIVE

To assess the attitudes of physicians prescribing medicines regarding EDSP from the perspective of EPV.

DESIGN

A cross-sectional study conducted from March 2019 to June 2019.

SETTING

5 government general hospitals in Hubei province, China.

PARTICIPANTS

405 physicians were randomly selected and 262 valid questionnaires were obtained.

OUTCOME MEASURES

A self-developed questionnaire, which inquired about the participant characteristics, perceptions and attitudes toward API pollution, EPV and EDSP from an EPV perspective, was emailed to collect data from physicians.

RESULTS

Most physicians agreed the existence of APIs in environment, worried about the potential environmental and ecological risks of API residues, supported the effectiveness and necessity of EDSP under an EPV perspective in decreasing environmental exposure of excreted APIs, and showed their willingness to participate in the EDSP practices. Nevertheless, no respondent identified the environmental impacts as the aspects regarding medicines affecting his(her) prescription decision, none was satisfied with knowledge on EDSP and showed confidence toward EDSP. The most important barrier to the effective implementation of EDSP was identified as 'poor awareness of EDSP and EPV'. Most responding physicians (97%) reported that they held the wait-and-see or conservative attitudes towards EDSP practice. The biggest concerns in low-dose prescribing and prescribing of drugs possessing environment-friendly excretion profiles, two EDSP approaches, were the possible negative impact on therapeutic outcomes and too complicated and professional drug evaluation process, respectively.

CONCLUSIONS

Chinese physicians had positive attitudes towards EDSP from the perspective of EPV. However, their environmental consciousness during prescribing and the related education were insufficient.