Antimicrobial Resistance in East Surabaya’s Sewage Sludge: Identifying an Emerging Health Risk for the Local Communities

Abstract

Antimicrobial resistance is a prevalent issue in Indonesia, as many current studies reported the high level of antimicrobial resistance in Indonesia (AMR). The main cause of this is the inappropriate usage of antimicrobial compounds, especially in the field of public health services and fishery. This study aims to identify the threats of antimicrobial resistance by analysing sludge in Surabaya’s sewages for signs of AMR. The methodology of this study works in three main stages, which are to isolate bacteria from sewage sludge samples, identify the isolate, and then test the antibiotic susceptibility of the bacterial isolates. A sludge sample is obtained from sewages near East Surabaya’s populace, with consideration of the sewage size and condition of each location. Isolation is then carried out for every sample which produces several microorganisms suspected as Salmonella, and many organisms that have yet to be identified. Identification used on this research include PCR and biochemical assay. Resistance test is then carried out using the agar well method according to CLSI standards, using 5 types of common antibiotics found in pharmacy clinic. List of antibiotics use includes Ciprofloxacin (CIP), Levofloxacin (LFX), Azithromycin (AZM), Amoxicillin-Clavulanate (AMC), and Sulfamethoxazole-Trimethoprim (SXT). Antibiotics are chosen based on the effect on various pathway, some antibiotics may be skipped because it’s not appropriate for usage in certain species of bacteria. Results of the test reveal a possible resistance from one isolate (S-45), with the results of biochemical assay pointing to the results shown for Shigella sp. This isolate has a marginal resistance towards LFX, based on the standards of CLSI M-100. The results shown a resistance with an average diameter of clear zone: 10.02 mm (LFX) which is the indication of resistance towards LFX standards (?16 mm) for Shigella sp.

Keywords:  Antibiotic-resistance; Agar well method; Biochemical assay; Diarrhea, Shigella