Accepted for/Published in: JMIR Research Protocols
Date Submitted: Aug 29, 2022
Date Accepted: Feb 28, 2023
Prevalence of antibiotics resistant pathogenic bacteria and level of antibiotic residues in the hospital effluents in Selangor: study protocol
ABSTRACT
Background:
Antimicrobial resistance (AMR) has emerged as one of public health challenges globally due to overused and misused of antibiotics by human and animals. Hospital is known to be one of highly antibiotic users.
Objective:
To determine the prevalence of antibiotics resistant pathogenic bacteria and level of antibiotic residues in the hospital’s effluent in Selangor, Malaysia.
Methods:
A cross-sectional study will be conducted in tertiary hospitals in Selangor, Malaysia. The hospital will be identified based on the inclusion and exclusion criteria of the study. The methods are divided into three sections; Sample collection, microbiological analysis and, chemical analysis. Microbiological analysis such as isolation of bacteria from the effluent by culture on selective media plates will be performed. An antibiotic sensitivity testing will be performed on the grown bacteria. The identified bacteria will be confirmed using 16sRNA PCR and Multiplex PCR will be performed to detect the resistant genes. Finally, the level of antibiotic residues will be measured using Ultra High Performance Liquid Chromatography (UHPLC)
Results:
The expected outcome will be the prevalence of antibiotic resistant 'ESKAPE' bacteria from the hospital’s effluent and the occurrence of the antibiotic resistant genes (ARGs) from the isolated ESKAPE bacteria and the level of antibiotic residues that may be detected from the effluent. Sampling has been conducted in three hospitals. As in July 2022, 80% of Enterococcus faecium were resistance against vancomycin and 10% of were resistance against ciprofloxacin from one hospital. Further analysis will be conducted to determine if the isolates are possessing any antibiotic resistant genes and effluent samples are being analyzed to detect antibiotic residues in the effluent samples. Sampling activities will be resumed actively after suspended due to COVID-19 pandemic and scheduled to end by December 2022.
Conclusions:
This study will be the first baseline information to elucidate the current status of AMR of highly pathogenic bacteria that present in the hospital effluent in Malaysia.
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