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Hospitals are repositories of multidrug-resistant organisms, but hospital wastewater routinely enters general urban and suburban sewage systems, with transfer of hospital-specific organisms into the local environment.
Researchers in France tested wastewater samples for extended-spectrum β-lactamase–producing Escherichia coli (ESBLEC) at multiple points in the wastewater network of a mid-size French city (population 120,000; 2 hospitals; 1 wastewater treatment plant). The overall concentration of E. coli was about half as high in hospital wastewater as in general urban wastewater, but the concentration of ESBLEC in hospital wastewater was >30-fold higher, and individual isolates were more resistant, particularly to ceftazidime and ofloxacin.
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