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Frontiers of Environmental Science & Engineering

Front. Environ. Sci. Eng.    2019, Vol. 13 Issue (3) : 45
Assessment of antibiotic resistance genes in dialysis water treatment processes
Xuan Zhu1, Chengsong Ye2, Yuxin Wang1, Lihua Chen2,3(), Lin Feng4()
1. No.2 Hospital of Xiamen City, Xiamen 361021, China
2. Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China
3. Faculty of Civil Engineering and Geosciences, Delft University of Technology, Delft 2600 AA, The Netherlands
4. School of the Environment, Renmin University of China, Beijing 100872, China
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• Quantitative global ARGs profile in dialysis water was investigated.

• Totally 35 ARGs were found in the dialysis treatment train.

• 29 ARGs (highest) were found in carbon filtration effluent.

erm and mtrD-02 occurred in the final effluent.

• The effluent was associated with health risks even after RO treatment.

Dialysis water is directly related to the safety of hemodialysis patients, thus its quality is generally ensured by a stepwise water purification cascade. To study the effect of water treatment on the presence of antibiotic resistance genes (ARGs) in dialysis water, this study used propidium monoazide (PMA) in conjunction with high throughput quantitative PCR to analyze the diversity and abundance of ARGs found in viable bacteria from water having undergone various water treatment processes. The results indicated the presence of 35 ARGs in the effluents from the different water treatment steps. Twenty-nine ARGs were found in viable bacteria from the effluent following carbon filtration, the highest among all of the treatment processes, and at 6.96 Log (copies/L) the absolute abundance of the cphA gene was the highest. Two resistance genes, erm (36) and mtrD-02, which belong to the resistance categories macrolides-lincosamides-streptogramin B (MLSB) and other/efflux pump, respectively, were detected in the effluent following reverse osmosis treatment. Both of these genes have demonstrated the potential for horizontal gene transfer. These results indicated that the treated effluent from reverse osmosis, the final treatment step in dialysis-water production, was associated with potential health risks.

Keywords Dialysis water      Treatment process      Antibiotic resistance gene      High-throughput quantitative PCR      Horizontal gene transfer     
This article is part of themed collection: Environmental Antibiotics and Antibiotic Resistance (Xin Yu, Hui Li & Virender K. Sharma)
Corresponding Authors: Lihua Chen,Lin Feng   
Issue Date: 26 June 2019
 Cite this article:   
Xuan Zhu,Chengsong Ye,Yuxin Wang, et al. Assessment of antibiotic resistance genes in dialysis water treatment processes[J]. Front. Environ. Sci. Eng., 2019, 13(3): 45.
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Xuan Zhu
Chengsong Ye
Yuxin Wang
Lihua Chen
Lin Feng
Fig.1  Process flow diagram. (TW-tap water, SF-sand filtration, WS-water softening, CF-carbon filtration, RO-reverse osmosis; 1-5 means the sampling port).
Temperature (°C) 21.24 20.28 20.42 20.78 25.60
DO (mg/L) 8.66 8.64 8.52 8.65 8.06
Residual chlorine (mg/L) 0.73 0.63 0.40 0.02 0.01
Conductivity (ms/cm) 91 106 112 92
pH 6.46 6.56 6.67 6.73 6.86
Turbidity (NTU) 0.17 0.20 0.18 0.23 0.08
NO3--N (mg/L) 1.73 1.95 2.13 1.73
NO2--N (mg/L)
NH4+-N (mg/L) 0.04 0.03 0.03 0.04 0.04
PO43--P (mg/L) 0.01 0.01 0.01
TOC (mg/L) 1.12 1.08 1.19 1.05 0.11
Ca2+ (mg/L) 8.62 8.00
Mg2+ (mg/L) 1.52 1.40 0.01
Total bacteria /100mL 3 60 130 1.15E+ 04 45
Tab.1  The physical and chemical parameters of different processes
Fig.2  Absolute abundance of ARGs. (TW-tap water, SF-sand filtration, WS-water softening, CF-carbon filtration, RO-reverse osmosis).
Fig.3  Distribution of ARGs from the different processes. (TW-tap water, SF-sand filtration, WS-water softening, CF-carbon filtration, RO-reverse osmosis).
Fig.4  Classification of antibiotic resistance gene based on the mechanism of resistance.
Fig.5  Profile of resistance genes. (TW-tap water, SF-sand filtration, WS-water softening, CF-carbon filtration, RO-reverse osmosis).
1 H K Allen, J Donato, H H Wang, K A Cloud-Hansen, J Davies, J Handelsman (2010). Call of the wild: Antibiotic resistance genes in natural environments. Nature Reviews. Microbiology, 8(4): 251–259 pmid: 20190823
2 E Barbau-Piednoir, S Bertrand, J Mahillon, N H Roosens, N Botteldoorn (2013). SYBR®Green qPCR Salmonella detection system allowing discrimination at the genus, species and subspecies levels. Applied Microbiology and Biotechnology, 97(22): 9811–9824 pmid: 24113820
3 C Bouki, D Venieri, E Diamadopoulos (2013). Detection and fate of antibiotic resistant bacteria in wastewater treatment plants: a review. Ecotoxicology and Environmental Safety, 91(4): 1–9 pmid: 23414720
4 M J Damasiewicz, K R Polkinghorne, P G Kerr (2012). Water quality in conventional and home haemodialysis. Nature Reviews. Nephrology, 8(12): 725–734 pmid: 23090444
5 Z Diao, H Sang (2015). Hemodialysis water treatment system and water quality monitoring. Medical Equipment, 28(1): 31–34
6 K Friehs (2004). Plasmid copy number and plasmid stability. Advances in Biochemical Engineering/Biotechnology, 86(1): 47–82 pmid: 15088763
7 N A Junglee, S U Rahman, M Wild, A Wilms, S Hirst, M Jibani, J R Seale (2010). When pure is not so pure: Chloramine-related hemolytic anemia in home hemodialysis patients. Hemodialysis International. International Symposium on Home Hemodialysis, 14(3): 327–332 pmid: 20618875
8 T Looft, T A Johnson, H K Allen, D O Bayles, D P Alt, R D Stedtfeld, W J Sul, T M Stedtfeld, B Chai, J R Cole, S A Hashsham, J M Tiedje, T B Stanton (2012). In-feed antibiotic effects on the swine intestinal microbiome. Proceedings of the National Academy of Sciences of the United States of America, 109(5): 1691–1696 pmid: 22307632
9 G Pontoriero, P Pozzoni, S Andrulli, F Locatelli (2004). The quality of dialysis water. Journal of Italian Nephrology, 21(Supplementary 30): S42–S45
pmid: 15747302
10 A Pruden, R Pei, H Storteboom, K H Carlson (2006). Antibiotic resistance genes as emerging contaminants: studies in northern Colorado. Environmental Science & Technology, 40(23): 7445–7450 pmid: 17181002
11 T Z Quan (2010). Selective detection of viable pathogens in water using propidium monoazide combined with qPCR and its application. Dissertation for the Doctoral Degree. Beijing: Tsinghua University (in Chinese)
12 M C Roberts (2003). Acquired tetracycline and/or macrolide-lincosamides-streptogramin resistance in anaerobes. Anaerobe, 9(2): 63–69 pmid: 16887689
13 M Rysz, P J J Alvarez (2004). Amplification and attenuation of tetracycline resistance in soil bacteria: Aquifer column experiments. Water Research, 38(17): 3705–3712 pmid: 15350422
14 T Schwartz, W Kohnen, B Jansen, U Obst (2003). Detection of antibiotic-resistant bacteria and their resistance genes in wastewater, surface water, and drinking water biofilms. FEMS Microbiology Ecology, 43(3): 325–335 pmid: 19719664
15 A Shahryari, M Nikaeen, M Hatamzadeh, M Vahid Dastjerdi, A Hassanzadeh (2016). Evaluation of bacteriological and chemical quality of dialysis water and fluid in Isfahan, central Iran. Iranian Journal of Public Health, 45(5): 650–656
pmid: 27398338
16 State Food & Drug Administration of China (2005). Standard for Water for Haemodialysis and Related Therapies. Beijing: State Food & Drug Administration of China
17 N van den Braak, A van Belkum, M van Keulen, J Vliegenthart, H A Verbrugh, H P Endtz (1998). Molecular characterization of vancomycin-resistant Enterococci from hospitalized patients and poultry products in The Netherlands. Journal of Clinical Microbiology, 36(7): 1927–1932
pmid: 9650938
18 T R Walsh, J Weeks, D M Livermore, M A Toleman (2011). Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: An environmental point prevalence study. Lancet. Infectious Diseases, 11(5): 355–362 pmid: 21478057
19 C Xi, Y Zhang, C F Marrs, W Ye, C Simon, B Foxman, J Nriagu (2009). Prevalence of antibiotic resistance in drinking water treatment and distribution systems. Applied and Environmental Microbiology, 75(17): 5714–5718 pmid: 19581476
20 W Xiong, Y Sun, T Zhang, X Ding, Y Li, M Wang, Z Zeng (2015). Antibiotics, antibiotic resistance genes, and bacterial community composition in fresh water aquaculture environment in China. Microbial Ecology, 70(2): 425–432 pmid: 25753824
21 L Xu, Y Qian, C Su, W Cheng, J Li, M L Wahlqvist, H Chen (2016). Prevalence of bacterial resistance within an eco-agricultural system in Hangzhou, China. Environmental Science and Pollution Research International, 23(21): 21369–21376 pmid: 27502562
22 S Zhang, C Ye, H Lin, L Lv, X Yu (2015). UV disinfection induces a VBNC state in Escherichia coli and Pseudomonas aeruginosa. Environmental Science & Technology, 49(3): 1721–1728 pmid: 25584685
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