(Editor's note: This story was corrected on July 12, 2013, from its original version.)
Research out of Virginia Tech last fall established that there is genetic material (i.e., DNA), associated with antibiotic resistance, in reclaimed wastewater, flowing out of Flagstaff's central sewage treatment plant -- but not actual live bacteria.
Laboratory methods can be used to isolate DNA in an attempt to learn more about organisms that may be present. In fact, it is not known yet if these DNA fragments have originated from dead (non-infectious) bacteria or living bacteria. The testing methods used cannot differentiate between live and dead bacteria.
But experts were split last week regarding what next steps the city should take to investigate whether this bacteria in reclaimed wastewater is a problem -- and whether it could be causing problems for people who visit Flagstaff parks and sports fields.
A couple of those on an 11-member panel say the city should request a public health study conducted by epidemiologists to quantify how many in Flagstaff have illnesses or injuries not responding to antibiotics.
"Is there a public health problem happening in the city of Flagstaff? That's something we should know," said David Engelthaler, director of TGen North and former state epidemiologist.
But emergency physician Robin Silver proposed the city take a look, and soon, at what's coming out of its sprinklers and other distribution points.
Silver raised concerns that the reclaimed water system might be a multiplying ground for bacteria resistant to some of the antibiotics he uses to treat life-threatening infections in the hospital.
"We found a difference in what was being delivered from the plant versus what was being distributed throughout the city," Silver told the group.
NOT ALLOWED TO DO NOTHING
The group making recommendations for the city of Flagstaff includes hydrologists, microbiologists and physicians, who met at the Flagstaff Aquaplex on Wednesday.
They were asked to evaluate the criteria used for drinking water and reclaimed wastewater when it comes to pharmaceuticals and organisms that might spread antibiotic-resistance.
There was some consensus that other agencies measuring health risks for chemical compounds in drinking water were adequately tracking chemicals that could cause cancer and other problems.
There was less consensus about whether antibiotic-resistant bacteria in reclaimed wastewater pose a health risk for humans.
These studies could be conducted on City Manager Kevin Burke's authority if they cost less than $50,000, or require a vote from the Flagstaff City Council.
"Here's the question I'm going to get from our community: 'Why are you going to wait for someone else to determine if there's a health effect?'" Burke told panelists, some of whom said other agencies could find the answers for Flagstaff. "... I don't think I'm going to be allowed to do nothing."
WHERE SICKNESS COMES FROM
Other ideas included: Tracking antibiotic-resistance via hospital data, comparing local hospital data to areas that don't have reclaimed wastewater, and attempting to establish how often people here were resistant to antibiotics some 20 years ago, before reclaimed wastewater was widely used in irrigation.
Those offering advice included the author of the Virginia Tech study, environmental microbiologist Amy Pruden.
This would be a good time to compare the characteristics of hospitalized patients who have antibiotic-resistant infections to what's found in the water, Pruden said
It isn't well-established where people most often contract bacteria that make antibiotics ineffective for them, she said.
"Most of the time when people get sick, we don't know where it came from," Pruden said.
The panelists sometimes debated each other heatedly about what to track, as they got down to next steps to propose.
"Should we start sampling the water for this bacteria?" Burke asked the group.
There was not much of a pause.
"Some of us feel strongly -- yes," Silver responded.
The forum was open to the public, but it saw few present as word about it was not widely distributed until less than one hour before the meeting began.
Cyndy Cole can be reached at firstname.lastname@example.org or at 913-8607.