Non-antimicrobial pharmaceuticals can affect the development of antibiotic resistance in hospital wastewater

Within this study, we were interested in the effects of wastewater on the development of antimicrobial resistance. Microorganisms can relatively promptly adapt to evolutionary pressures of the environment, including antibiotics. Therefore, we tested how the adaptability of the model microorganism Salmonella enterica is affected by wastewater full of pharmaceuticals, illicit drugs, and other micropollutants. Wastewater samples had been taken from effluent of hospitals and from wastewater treatment plant (WWTP) Petržalka influent and effluent. In these samples, presence of 38 substances was monitored. The highest concentration was observed in case of tramadol, citalopram, venlafaxine, cotinine, atenolol, valsartan, carbamazepine, azithromycin, and ciprofloxacin. According to this data, we focused also on individual pharmaceutical compounds presented in wastewater samples in elevated concentrations. Effect on resistance development of two pain relief medications (carbamazepine, tramadol), hypotensive medications (atenolol, valsartan), and the nicotine metabolite (cotinine) was also investigated. For this study, we employed concentrations presented in wastewater as well as in urine of patients and/or users. To determine the frequency of mutations leading to ciprofloxacin resistance, we applied the modified Ames test employing the strain Salmonella Typhimurium. Resistance index increased in the case of all wastewater samples from conventional hospitals where we observed a 1.22-1.69-fold increase of mutations leading to ciprofloxacin resistance. Tested compounds caused rise of resistance index in lower concentrations found in wastewater. The most significant increase of resistance index was detected after carbamazepine treatment.