Ohlsen K, Ternes T, Werner G, Wallner U, Loffler D, Ziebuhr W, Witte W, Hacker J (2003): Impact of antibiotics on conjugational resistance gene transfer in Staphylococcus aureus in sewage
Environ. Microbiol. 5 (8): 711-716.

The growing rate of microbial pathogens becoming resistant to standard antibiotics is an important threat to public health. In order to assess the role of antibiotics in the environment on the spread of resistance factors, the impact of subinhibitory concentrations of antibiotics in sewage on gene transfer was investigated using conjugative gentamicin resistance (aacA-aphD) plasmids of Staphylococcus aureus. Furthermore, the concentration of antibiotics in hospital sewage was measured by high-performance liquid chromatography (HPLC)-electrospray tandem mass spectrometry. Several antibiotics were found to be present in sewage, e.g. ciprofloxacin up to 0.051 mg l(-1) and erythromycin up to 0.027 mg l(-1) . Resistance plasmid transfer occurred both on solidified (dewatered) sewage and in liquid sewage in a bioreactor with a frequency of 1.1 x 10(-5) -5.0 x 10(-8). However, low-level concentrations of antibiotics measured in sewage are below concentrations that can increase plasmid transfer frequencies of gentamicin resistance plasmids of staphylococci.