title: Ciprofloxacin residue and antibiotic-resistant biofilm bacteria in hospital effluent.
abstract: Discharge of antimicrobial residues and resistant bacteria in hospital effluents is supposed to have strong impacts on the spread of antibiotic resistant bacteria in the environment. This study aimed to characterize the effluents of the Gabriel Montpied teaching hospital, Clermont-Ferrand, France, by simultaneously measuring the concentration of ciprofloxacin and of biological indicators resistant to this molecule in biofilms formed in the hospital effluent and by comparing these data to ciprofloxacin consumption and resistant bacterial isolates of the hospital. Determination of the measured environmental concentration of ciprofloxacin by spot sampling and polar organic chemical integrative (POCIS) sampling over 2 weeks, and comparison with predicted environmental concentrations produced a hazard quotient >1, indicating a potential ecotoxicological risk. A negative impact was also observed with whole hospital effluent samples using the Tetrahymena pyriformis biological model. During the same period, biofilms were formed within the hospital effluent, and analysis of ciprofloxacin-resistant isolates indicated that Gamma-Proteobacteria were numerous, predominantly Aeromonadaceae (69.56%) and Enterobacteriaceae (22.61%). Among the 115 isolates collected, plasmid-mediated fluoroquinolone-resistant genes were detected, with mostly aac(6')-lb-cr and qnrS. In addition, 60% of the isolates were resistant to up to six antibiotics, including molecules mostly used in the hospital (aminosides and third-generation cephalosporins). In parallel, 1247 bacteria isolated from hospitalized patients and resistant to at least one of the fluoroquinolones were collected. Only 5 of the 14 species identified in the effluent biofilm were also found in the clinical isolates, but PFGE typing of the Gram-negative isolates found in both compartments showed there was no clonality among the strains. Altogether, these data confirm the role of hospital loads as sources of pollution for wastewater and question the role of environmental biofilms communities as efficient shelters for hospital-released resistance genes.
authors.affiliation: Université Clermont Auvergne, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; Université Clermont Auvergne, Université d'Auvergne, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; CNRS, UMR 6023, LMGE, F-63170, Campus Universitaire des Cézeaux, France; Service d'hygiène, CHU de Clermont-Ferrand, rue Montalembert, 63003, Clermont-Ferrand, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Ory
authors.affiliation: Université Clermont Auvergne, Université Blaise Pascal, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; CNRS, UMR 6023, LMGE, F-63170, Campus Universitaire des Cézeaux, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Bricheux
authors.affiliation: Bureau de recherches géologiques et minières (BRGM), 3 avenue Claude Guillemin, F-45100, Orléans, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Togola
authors.affiliation: Université Clermont Auvergne, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; Université Clermont Auvergne, Université d'Auvergne, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; CNRS, UMR 6023, LMGE, F-63170, Campus Universitaire des Cézeaux, France.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Bonnet
authors.affiliation: Université Clermont Auvergne, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; Université Clermont Auvergne, Université Blaise Pascal, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; CNRS, UMR 6023, LMGE, F-63170, Campus Universitaire des Cézeaux, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Donnadieu-Bernard
authors.affiliation: Université Clermont Auvergne, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; Université Clermont Auvergne, Université d'Auvergne, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; CNRS, UMR 6023, LMGE, F-63170, Campus Universitaire des Cézeaux, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Nakusi
authors.affiliation: Université Clermont Auvergne, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; Université Clermont Auvergne, Université d'Auvergne, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; CNRS, UMR 6023, LMGE, F-63170, Campus Universitaire des Cézeaux, France.
authors.forename: Christiane
authors.initials: C
authors.lastname: Forestier
authors.affiliation: Université Clermont Auvergne, Université d'Auvergne, Laboratoire "Microorganismes: Génome et Environnement", BP 10448, F-63000, Clermont-Ferrand, France; CNRS, UMR 6023, LMGE, F-63170, Campus Universitaire des Cézeaux, France; Service d'hygiène, CHU de Clermont-Ferrand, rue Montalembert, 63003, Clermont-Ferrand, France. Electronic address: otraore@chu-clermontferrand.fr.
authors.forename: Ousmane
authors.initials: O
authors.lastname: Traore
mesh_terms: D000900:Anti-Bacterial Agents / Q000032:analysis* / Q000494:pharmacology; D001419:Bacteria / Q000187:drug effects / Q000235:genetics / Q000254:growth & development*; D018441:Biofilms; D002939:Ciprofloxacin / Q000032:analysis* / Q000494:pharmacology; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005602:France; D005798:Genes, Bacterial; D006761:Hospitals; D006801:Humans; D010957:Plasmids; D062065:Wastewater / Q000737:chemistry / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D062065:Wastewater
keywords: Antibioresistance; Biofilm; Effluent hospital; POCIS; fluoroquinolones