Quantitative Microbial Risk Assessment of Antimicrobial Resistant and Susceptible Staphylococcus aureus in Reclaimed Wastewaters

Mary E. Schoen, Michael A. Jahne, Jay Garland, Lucia Ramirez, Allison J. Lopatkin, Kerry A. Hamilton

Research output: Contribution to journalArticlepeer-review

Abstract

The annual risks of colonization, skin infection, bloodstream infection (BSI), and disease burden from exposures to antibiotic-resistant and susceptible Staphylococcus aureus (S. aureus) were estimated using quantitative microbial risk assessment (QMRA). We estimated the probability of nasal colonization after immersion in wastewater (WW) or greywater (GW) treated across a range of treatment alternatives and subsequent infection. Horizontal gene transfer was incorporated into the treatment model but had little effect on the predicted risk. The cumulative annual probability of infection (resulting from self-inoculation) was most sensitive to the treatment log10 reduction value (LRV), S. aureus concentration, and the newly calculated morbidity ratios and was below the health benchmark of 10-4 infections per person per year (ppy) given a treatment LRV of roughly 3.0. The predicted annual disability-adjusted life years (DALYs), which were dominated by BSI, were below the health benchmark of 10-6 DALYs ppy for resistant and susceptible S. aureus, given LRVs of 4.5 and 3.5, respectively. Thus, the estimated infection risks and disease burdens resulting from nasal colonization are below the relevant health benchmarks for risk-based, nonpotable, or potable reuse systems but possibly above for immersion in minimally treated GW or WW. Strain-specific data to characterize dose-response and concentration in WW are needed to substantiate the QMRA.

Original languageEnglish (US)
Pages (from-to)15246-15255
Number of pages10
JournalEnvironmental Science and Technology
Volume55
Issue number22
DOIs
StatePublished - Nov 16 2021
Externally publishedYes

Keywords

  • MRSA
  • QMRA
  • Staphylococcus aureus
  • antimicrobial resistance
  • greywater
  • horizontal gene transfer
  • reclaimed
  • wastewater

ASJC Scopus subject areas

  • Chemistry(all)
  • Environmental Chemistry

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