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Environmental pollution with antimicrobial agents from bulk drug manufacturing industries in Hyderabad, South India, is associated with dissemination of extended-spectrum beta-lactamase and carbapenemase-producing pathogens

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Abstract

Purpose

High antibiotic and antifungal concentrations in wastewater from anti-infective drug production may exert selection pressure for multidrug-resistant (MDR) pathogens. We investigated the environmental presence of active pharmaceutical ingredients and their association with MDR Gram-negative bacteria in Hyderabad, South India, a major production area for the global bulk drug market.

Methods

From Nov 19 to 28, 2016, water samples were collected from the direct environment of bulk drug manufacturing facilities, the vicinity of two sewage treatment plants, the Musi River, and habitats in Hyderabad and nearby villages. Samples were analyzed for 25 anti-infective pharmaceuticals with liquid chromatography–tandem mass spectrometry and for MDR Gram-negative bacteria using chromogenic culture media. In addition, specimens were screened with PCR for bla VIM, bla KPC, bla NDM, bla IMP-1, and bla OXA-48 resistance genes.

Results

All environmental specimens from 28 different sampling sites were contaminated with antimicrobials. High concentrations of moxifloxacin, voriconazole, and fluconazole (up to 694.1, 2500, and 236,950 µg/L, respectively) as well as increased concentrations of eight other antibiotics were found in sewers in the Patancheru–Bollaram industrial area. Corresponding microbiological analyses revealed an extensive presence of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae and non-fermenters (carrying mainly bla OXA-48, bla NDM, and bla KPC) in more than 95% of the samples.

Conclusions

Insufficient wastewater management by bulk drug manufacturing facilities leads to unprecedented contamination of water resources with antimicrobial pharmaceuticals, which seems to be associated with the selection and dissemination of carbapenemase-producing pathogens. The development and global spread of antimicrobial resistance present a major challenge for pharmaceutical producers and regulatory agencies.

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Author contributions

Study conception and design: CL, CB, ACR, and FS. Identification of sampling sites and acquisition of data: CL, CB, and AD. Provision of documentary images: CL and CB. Performance of the laboratory experiments: NL and MK. Data analysis and interpretation of the results: CL, CB, NL, TE, ACR, MK, and FS. Drafting of the manuscript: CL. Critical revision of the manuscript: CL, CB, AD, TE, NL, ACR, MK, and FS.

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Author notes

    Authors and Affiliations

    1. Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany

      Christoph Lübbert

    2. Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, 04103, Leipzig, Germany

      Christoph Lübbert, Norman Lippmann & Arne C. Rodloff

    3. Ressort Investigation, North German Broadcasting Corporation (NDR), Hugh-Greene-Weg 1, 22529, Hamburg, Germany

      Christian Baars

    4. NGO Gamana, Gayatri Millennium Enclave Plot 1, Arunodaya Colony, Madhapur, Hyderabad, 500033, India

      Anil Dayakar

    5. Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstr. 21, 04103, Leipzig, Germany

      Norman Lippmann & Arne C. Rodloff

    6. IBMP-Institute for Biomedical and Pharmaceutical Research, Paul-Ehrlich-Str. 19, 90562, Nürnberg-Heroldsberg, Germany

      Martina Kinzig & Fritz Sörgel

    7. Institute of Pharmacology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany

      Fritz Sörgel

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    Correspondence to Christoph Lübbert.

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    The authors did not receive any external funding.

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    A. C. Rodloff, M. Kinzig, and F. Sörgel contributed equally as senior authors.

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    Lübbert, C., Baars, C., Dayakar, A. et al. Environmental pollution with antimicrobial agents from bulk drug manufacturing industries in Hyderabad, South India, is associated with dissemination of extended-spectrum beta-lactamase and carbapenemase-producing pathogens. Infection 45, 479–491 (2017). https://doi.org/10.1007/s15010-017-1007-2

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    • DOI: https://doi.org/10.1007/s15010-017-1007-2

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