Hospital sewers as an arena for selection and evolution of antibiotic resistance

The growing problem with antibiotic resistant bacteria has emerged as a severe threat to public health globally.

The environment serves as a source for resistance genes that over time are transferred horizontally into human pathogens.

While excreted antibiotics from human use contaminate the environment, it is unclear if this leads to a selection pressure that promotes resistant bacteria.

Earlier this year, however, we provided conclusive evidence for strong selection of multi-resistant E. coli by wastewater from the Sahlgrenska University Hospital in Gothenburg.

This project aim to identify the chemical agents responsible for the strong selection pressure recently identified in hospital wastewater.

We will also characterize how widespread such selection pressures are through investigations of wastewaters at many hospitals, including comparisons with samples from other parts of the sewer systems.

Finally, we will investigate if microbial biofilms in hospital sewers are plausible arenas for resistance evolution, by studying selection, accumulation of resistant bacteria, and the presence of emerging resistance factors.

By identifying causes and characterizing risks, the proposed research will provide critical information for mitigation strategies, including possible efforts to treat hospital wastewater locally.

Through active collaboration with hospitals and the water sector throughout the project, we will ensure that the most urgent questions are effectively addressed.