Abstract
Due to wide and intensive use of antibiotics, antibiotics resistant bacteria (ARB) were often detected from water environment receiving various effluents. We developed a method to estimate the burden of infectious diseases caused by waterborne ARB, which can reflect difficulty in treatment of ARB infection, by applying concept of DALY modified with PK/PD model. Using the developed method, burdens of skin infectious diseases in bathing at beaches and river and in working at paddy fields were estimated, taking existence of ARBs to cefepime and cyprofloxacin into account. For this estimation, new doseresponse models available for skin infection by three species of bacteria (Pseudomonas aeruginosa, Staphylococcus aureus and Group A Streptococci) were proposed. Although it is a rough estimation of based on the small number of samples, the result demonstrates that the existence of ARBs in water environment increased the burden of skin infectious diseases in most exposure scenarios. The maximum increase (7.7 times) of DALY was observed in S. aureus infection via bathing in treated municipal wastewater due to a high rate of its resistance to cefepime. The DALY lost by bathing in a river that does not receive the treated wastewater was significantly lower, indicating that its discharge would pose risk of skin infection to those bathe at the downstream. The DALY lost by the activities in paddy fields using organic fertilizer was much higher than in those using chemical fertilizer due to both higher concentration and resistance rate of the causal bacteria. And the DALY lost by bathing in beaches was low enough even in the swimming season.
