The development of antibiotic resistance and dissemination of its determinants is an emerging public health problem as it compromises treatment options of infections that were, until recently, treatable. Investigation of outbreaks of vancomycin resistant enterococci (VRE) suggests that the environment serves as a significant reservoir for antibiotic resistance genes (ARGs). However, there is a paucity of data regarding the presence of ARGs in the water sources in South Africa. In this study, water samples collected from wastewater treatment plants (WWTPs), surface water and hospital sewage were screened for enterococci harbouring genes conferring resistance to four classes of antibiotics. Enterococci isolates harbouring ARGs were detected in raw influent and treated wastewater discharge from WWTPs and hospital sewage water. Plasmid and transposon encoded ermB (macrolide), tetM and tetL (tetracycline) as well as aph(3’)-IIIa (aminoglycosides) genes were frequently detected among the isolates, especially in E. faecalis. The presence of enterococci harbouring ARGs in the treated wastewater suggest that ARGs are discharged into the environment where their proliferation could be perpetuated. Among the enterococci clonal complexes (CCs) recovered from wastewater were E. faecium CC17 (ST18), which is frequently associated with hospital outbreaks and a novel E. faecalis sequence type (ST), ST780.

Concerning PM2.5 concentrations, rapid industrialization, along with increase in cardiovascular disease (CVD) were recorded in Pakistan, especially in urban areas. The degree to which air pollution contributes to the increase in the burden of CVD in Pakistan has not been assessed due to lack of data. This study aims to describe the characteristics of PM2.5 constituents and investigate the impact of individual PM2.5 constituent on cardiovascular morbidity in Karachi, a mega city in Pakistan. Daily levels of twenty-one constituents of PM2.5 were analyzed using samples collected at two sites from fall 2008 to summer 2009 in Karachi. Hospital admission and emergency room visits due to CVD were collected from two large hospitals. Negative Binominal Regression was used to estimate associations between pollutants and the risk of CVD. All PM2.5 constituents were assessed in single-pollutant models and selected constituents were assessed in multi-pollutant models adjusting for PM2.5 mass and gaseous pollutants. The most common CVD subtypes among our participants were ischemic heart disease, hypertension, heart failure, and cardiomyopathy. Extremely high levels of PM2.5 constituents from fossil-fuels combustion and industrial emissions were observed, with notable peaks in winter. The most consistent associations were found between exposure to nickel (5–14% increase per interquartile range) and cardiovascular hospital admissions. Suggestive evidence was also observed for associations between cardiovascular hospital admissions and Al, Fe, Ti, and nitrate. Our findings suggested that PM2.5 generated from fossil-fuels combustion and road dust resuspension were associated with the increased risk of CVD in Pakistan.

Conjunctivitis has hazardous effects on patients’ quality of life through influencing school performance, work productivity, and daily activities such as driving. However, limited evidence is available on the contributory role of air pollution on conjunctivitis, particularly in China.We obtained data of 81,351 conjunctivitis outpatients from the largest comprehensive hospitals of four cities, China, between Jan 1, 2013 and Dec 31, 2014. Data on air pollutants, including particulate matter ≤2.5 μm in diameter (PM₂.₅), particulate matter ≤10 μm in diameter (PM₁₀), nitrogen dioxide (NO₂), ozone (O₃) and sulphur dioxide (SO₂) were collected from China National Environmental Monitoring Centre. Conjunctivitis outpatient visits were linked with air pollution concentrations by the visiting dates. A time-stratified case-crossover design with conditional logistic regression model was used to examine the effect of short-term exposure to air pollution on conjunctivitis outpatient visits.We found that the associations between air pollutants (per 10 μg/m³ increase) and hospital outpatient visits for asthma were [odds ratios (ORs) and 95% confidence intervals]: 1.004(1.002–1.007) for PM₂.₅, 1.004 (1.002–1.005) for PM₁₀, 1.012(1.005–1.020) for NO₂, 1.006 (1.001–1.011) for SO₂, and 1.007 (1.003–1.010) for O₃, respectively at lag0 day. Outpatients aged 35–64 years showed significant associations with exposure to PM₂.₅ (1.005, 1.001–1.010), PM₁₀ (1.005, 1.002–1.008), NO₂ (1.014, 1.003–1.026), and O₃ (1.005, 1.000–1.011), while those aged 15–34 years showed significant associations with exposure to O₃ (1.010, 1.004–1.017).Short-term exposure to air pollution has impacts on outpatient visits for conjunctivitis in China. This study suggests that improving air quality could protect eye health.

Autism spectrum disorder (ASD) affects more boys than girls. Recent animal studies found that early life exposure to ambient particles caused autism-like behaviors only in males. However, there has been little study of sex-specificity of effects on ASD in humans. We evaluated ASD risk associated with prenatal and first year of life exposures to particulate matter less than 2.5 μm in aerodynamic diameter (PM₂.₅) by child sex. This retrospective cohort study included 246,420 singleton children born in Kaiser Permanente Southern California (KPSC) hospitals between 1999 and 2009. The cohort was followed from birth through age five to identify 2471 ASD cases from the electronic medical record. Ambient PM₂.₅ and other regional air pollution measurements (PM less than 10 μm, ozone, nitrogen dioxide) from regulatory air monitoring stations were interpolated to estimate exposure during each trimester and first year of life at each geocoded birth address. Hazard ratios (HRs) were estimated using Cox regression models to adjust for birth year, KPSC medical center service areas, and relevant maternal and child characteristics. Adjusted HRs per 6.5 μg/m³ PM₂.₅ were elevated during entire pregnancy [1.17 (95% confidence interval (CI), 1.04–1.33)]; first trimester [1.10 (95% CI, 1.02–1.19)]; third trimester [1.08 (1.00–1.18)]; and first year of life [1.21 (95% CI, 1.05–1.40)]. Only the first trimester association remained robust to adjustment for other exposure windows, and was specific to boys only (HR = 1.18; 95% CI, 1.08–1.27); there was no association in girls (HR = 0.90; 95% CI, 0.76–1.07; interaction p-value 0.03). There were no statistically significant associations with other pollutants. PM₂.₅-associated ASD risk was stronger in boys, consistent with findings from recent animal studies. Further studies are needed to better understand these sexually dimorphic neurodevelopmental associations.

Dairy cattle of different ages experience different living conditions and varied frequency of antibiotic administration that likely influence the distribution of microbiome and resistome in ways that reflect different risks of microbial transmission. To assess the degree of variance in these distributions, fecal and soil samples were collected from six distinct housing areas on commercial dairy farms (n = 7) in Washington State. 16S rRNA gene sequencing indicated that the microbiota differed between different on-farm locations in feces and soil, and in both cases, the microbiota of dairy calves was often distinct from others (P < 0.05). Thirty-two specific antibiotic resistance genes (ARGs) were widely distributed on dairies, of which several clinically relevant ARGs (including cfr, cfrB, and optrA) were identified for the first time at U.S. dairies. Overall, ARGs were observed more frequently in feces and soil from dairy calves and heifers than from hospital, fresh, lactation and dry pens. Droplet-digital PCR demonstrated that the absolute abundance of floR varied greatly across housing areas and this gene was enriched the most in calves and heifers. Furthermore, in an extended analysis with 14 dairies, environmental soils in calf pens had the most antibiotic-resistant Escherichia coli followed by heifer and hospital pens. All soil E. coli isolates (n = 1,905) are resistant to at least 4 different antibiotics, and the PFGE analysis indicated that florfenicol-resistant E. coli is probably shared across geographically-separated farms. This study identified a discrete but predictable distribution of antibiotic resistance genes and organisms, which is important for designing mitigation for higher risk areas on dairy farms.

Many cities in China are currently experiencing severe air pollution due to modernization. Previous studies investigating the effects of air pollutants exposure were particularly conducted in severe air polluted area and studies in low pollution areas were sparse.To quantitatively assess the short-term effects of ambient air pollutants (PM2.5, PM10, SO2, NO2, CO and O3) on outpatient visits in low pollution area, we conducted a time-series analysis from Jan 1, 2015 to Dec 31, 2016 in Shennongjia, China. Generalized additive model (GAM) was used to evaluate the influence of PM2.5 on daily hospital outpatient visits with different lag structures. We also conducted stratified analysis to explore the association between PM2.5 concentration and outpatient visits in different seasons.In the present study, per IQR increment of PM2.5, PM10, NO2, CO and O3 were related with 1.92% (0.76%–3.09%), 1.92% (0.77%–3.07%), 2.74% (95% CI: 1.65%–3.83%), 1.89% (95% CI: 0.68%–3.10%) and 2.30% (95% CI: 0.65%–3.95%) increase on respiratory outpatient visits. Significant associations were found between PM2.5, PM10, NO2 and respiratory outpatient visits at lag0:1, lag0:2 days. The effects of PM2.5 were more evident in the cool season than in the warm season.Our study showed that short-term exposures to PM2.5, PM10, NO2, CO and O3 were related with increased risk of outpatient visits of respiratory diseases, and highlighted the adverse effect of air pollutants exposure, especially PM2.5 exposure in cool season on health in low pollution area.

Environmental reservoirs of antibiotic resistance (AR) are a growing concern that are gathering more attention as potential sources for human infection. Carbapenem-resistant Enterobacteriaceae (CRE) are extremely dangerous, as carbapenems are often drugs of last resort that are used to treat multi-drug resistant infections. Among the genes capable of conferring carbapenem resistance to bacteria, the most transferrable are those that produce carbapenemase, an enzyme that hydrolyzes carbapenems and other β-lactam antibiotics. The goal of this review was to comprehensively identify global environmental reservoirs of carbapenemase-producing genes, as well as identify potential routes of transmission to humans. The genes of interest were Klebsiella pneumoniae carbapenemase (KPC), New Delhi Metallo-β-lactamase (NDM), Oxacillinase-48-type carbapenemases (OXA-48), and Verona Integron-Mediated Metallo-β-lactamase (VIM). Carbapenemase genes have been reported in the environment on almost every continent. Hospital and municipal wastewater, drinking water, natural waterways, sediments, recreational waters, companion animals, wildlife, agricultural environments, food animals, and retail food products were identified as current reservoirs of carbapenemase-producing bacteria and genes. Humans have been recorded as carrying CRE, without recent admittance to a hospital or long-term care facility in France, Egypt, and China. CRE infections from the environment have been reported in patients in Montpellier, France and Cairo, Egypt. This review demonstrates the need for 1) comprehensive monitoring of AR not only in waterways, but also other types of environmental matrices, such as aerosol, dusts, periphyton, and surfaces in indoor environments; and 2) action to reduce the prevalence and mitigate the effects of these potentially deadly resistance genes. In order to develop an accurate quantitative model for environmental dimensions of AR, longitudinal sampling and quantification of AR genes and bacteria are needed, using a One Health approach.

The pollution of antibiotics and antibiotic resistance genes (ARGs) has been highlighted on a global scale because of their serious threats to the environment and human health. Typical urban water in cities with high population density are ideal mediums for the acquisition and spread of antibiotics and ARGs. The pollution level of a broad range of antibiotics and ARGs in hospital wastewater, groundwater and the Wenyu River, and their fates through three sewage treatment plants (STPs) were investigated in this study. The concentrations of the 11 detected antibiotics ranged from not detected (ND)-16800 ng L⁻¹ in diverse water samples from Beijing, and fluoroquinolones were detected at the highest concentration, especially in the hospital samples. The maximum concentrations of antibiotics in STPs and hospital were 1–3 orders of magnitude higher than those in the surface water from Wenyu River and groundwater. Good removal efficiencies by treatment processes were observed for tetracyclines and quinolones, and low removal efficiencies were observed for sulfonamides and macrolides. These results also revealed that the sulfonamide resistance genes (sul1, sul2) and macrolide resistance genes (ermB) were detected at the highest relative abundances (7.11 × 10⁻²-1.18 × 10⁻¹) in the water bodies of Beijing. It was worth noting that sul1 abundance was the highest in groundwater samples. The relative abundance of most ARGs in STPs exhibited a declining trend in the order of influent > secondary effluents > effluent. However, the relative abundance of sul 1, sul 2 and tetC in the effluent was higher than those in the influent. The incomplete removal of antibiotics and ARGs in STPs poses a serious threat to the receiving rivers, and affects ecosystem security. Overall, our findings provide favorable support for a further investigation of the spread and risk of antibiotics and ARGs from diverse sources (e.g., STPs and hospitals) to the aquatic environment.

A number of systematic reviews have investigated the association between air pollutants and health impacts, these mostly focus on morbidity and mortality from hospital data. Previously, no reviews focused solely on ambulance dispatch data. These data sets have excellent potential for environmental health research. For this review, publications up to April 2019 were identified using three main search categories covering: ambulance services including dispatches; air pollutants; and health outcomes. From 308 studies initially identified, 275 were excluded as they did not relate to ambulance service dispatches, did not report the air pollutant association, and/or did not study ambient air pollution. The main health outcomes in the remaining 33 studies were cardiac arrest (n = 14), cardiovascular (n = 11) and respiratory (n = 10) dispatches. Meta-analyses were performed to summarise pooled relative risk (RR) of pollutants: particulate matter less than 2.5 and 10 μm (PM₂.₅, PM₁₀), the fraction between PM₁₀ and PM₂.₅ (coarse) and suspended particulate matter (SPM) per 10 μg/m³ increase, carbon monoxide (CO) per 1 ppm increase and of sulphur dioxide (SO₂), nitrogen dioxide (NO₂), and ozone (O₃) per 10 ppb increment and ambulance dispatches. Statistically significant associations were found for ambulance dispatch data for all-respiratory and PM₂.₅ at 1.03 (95% CI:1.02–1.04) and at 1.10 (95% CI:1.00–1.21) for asthma and NO₂ associations. For dispatches with subsequent paramedic assessment for cardiac arrest with PM₂.₅, CO and coarse dispatches at 1.05 (95% CI:1.03–1.08), 1.10 (95% CI:1.02–1.18) and 1.04 (95% CI:1.01–1.06) respectively. For dispatches with subsequent physician diagnosis for all-respiratory and PM₂.₅ at 1.02 (95% CI:1.01–1.03). In conclusion, air pollution was significantly associated with an increase in ambulance dispatch data, including those for cardiac arrest, all-respiratory, and asthma dispatches. Ambulance services should plan accordingly during pollution events. Furthermore, efforts to improve air quality should lead to decreases in ambulance dispatches.

This study focused on the presence of three biocidal products specific to healthcare facilities, i.e. chlorhexidine digluconate (CHD), bis(aminopropyl)laurylamine (BAPLA), and didecyldimethylammonium chloride (DDAC), in a hospital sewage system. Five sampling campaigns were conducted in 2016 and 2017 throughout the entire Poitiers University Hospital sewage system. DDAC concentrations ranging from 933 ± 119 to 3250 ± 482 μg/L were detected in 24-h composite samples, while lower concentrations (both within the same range) were detected for the two other compounds (i.e. 25 ± 5 to 97 ± 39 μg/L for CHD and 18 ± 3 to 142 ± 16 μg/L for BAPLA). Based on these findings, a mass balance was determined for these discharged compounds to compare the quantities detected in discharges to the amounts used for healthcare in the hospital. Hence, 60–90% of the quantities of DDAC used were found to be present at the hospital sewage outfall. Higher percentages of CHD (100–242%) were noted because of the high presumably quantities used for antiseptic applications, which were not considered in mass balance calculation. Finally, only 10–30% of BAPLA quantities used were detected at the site outfall. Analysis of the results for the different sampling points revealed the nature of the emission sources. For surface applications of DDAC and BAPLA, management of hospital linen is thus a major source of discharged biocidal products, probably following the washing of biocide-soaked textiles used for hospital facility maintenance. Moreover, discharge of biocidal products from a healthcare establishment depends especially on biocide handling practices in the emitting establishment. For BAPLA, compliance with hospital recommended dosages and practices whereby operators are required to prepare tailored quantities of detergents and disinfectants for each specific task could largely explain the limited release of this compound.