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Inactivation of carbapenem-resistant Klebsiella pneumoniae by photo-Fenton: Residual effect, gene evolution and modifications with citric acid and persulfate

Serna-Galvis, Efraím A., Vélez-Peña, Estefanía, Osorio-Vargas, Paula, Jiménez, J. Natalia, Salazar-Ospina, Lorena, Guaca-González, Yina M., Torres-Palma, Ricardo A.
Water research 2019 v.161 pp. 354-363
Klebsiella pneumoniae, antibiotic resistance, bacteria, carbapenems, citric acid, disinfection, genes, hospitals, hydrogen peroxide, hydroxyl radicals, iron, pathogens, residual effects, selective media, wastewater, Colombia
The photo-Fenton process application to eliminate carbapenem-resistant Klebsiella pneumoniae, an antibiotic-resistant priority pathogen, was evaluated. Initially, reagents concentration effect was tested and under suitable conditions (5 mg L−1 of Fe2+ and 50 mg L−1 of H2O2) complete bacteria inactivation by action of hydroxyl radical and UVA plus hydrogen peroxide was achieved at 120 min. The process presented a strong residual disinfecting effect when light was turned off at only 20 min. Besides, the cultivability of treated K. pneumoniae in a selective medium containing carbapenem antibiotics was considered. bla-KPC, gene responsible for the resistance, evolution was also assessed. The bacteria response to carbapenem antibiotics was higher as the treatment time increased. In turn, bla-KPC gene remained when K. pneumoniae was completely inactivated (120 min); nevertheless, treatment times longer than 120 min diminished bla-KPC presence. Finally, the photo-Fenton process and its modifications (citric acid addition or persulfate anion instead hydrogen peroxide) were applied to a real hospital wastewater in Colombia. In such complex matrix, the conventional photo-Fenton system reached a moderate disinfection (∼3.5 log-units at 300 min). Meanwhile, in presence of citric acid total inactivation was completed at the same time. Interestingly, the H2O2 substitution by persulfate strongly accelerated the microorganism elimination, achieving the 6-log-units reduction after only 60 min of process action. Thus, the effective elimination of K. pneumoniae from water by the modified photo-Fenton evidenced the potential applicability of this process to limit the proliferation of antibiotic resistant bacteria.