Schmitt H, Blaak H, Kemper MA, de Rijk SE, van de Schans M, de Roda Husman AM
RIVM Report 2018-0114
Carbapenemase-producing Enterobacteriaceae (CPE) can cause infections that are difficult to treat with the commonly used antibiotics. They are therefore a threat to public health. Accordingly, it's important to ensure that these resistant bacteria do not spread further in human beings and in the environment.
RIVM has investigated whether it would make sense to treat hospital waste water in order to combat the spread of CPE in the environment. However, it turns out that hospital waste water contains only a small fraction of all the CPE bacteria that end up in surface water via waste water. This measure would therefore not substantially reduce the number of CPE that enter the environment.
Antibiotic-resistant bacteria end up in waste water treatment facilities via human faeces from hospitals and from the general population. As they are not completely removed there, they then end up in surface water. For this investigation, the waste water from five hospitals and the associated waste water treatment facilities was analysed during 24 hours. The quantity of CPE found varied greatly over time. Generally, less than 10% of the total amount of CPE in the waste water treatment facilities comes from hospital waste water. For some hospitals (one third of the measurements), these numbers can increase to 10 to 60% at certain moments. It was also found that only a small part of antibiotic residues originates in hospital waste water.