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Conforti S, Holschneider A, Sylvestre É, Julian TR. Monitoring ESBL- Escherichia coli in Swiss wastewater between November 2021 and November 2022: insights into population carriage. mSphere 2024; 9:e0076023. [PMID: 38606968 DOI: 10.1128/msphere.00760-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Antimicrobial resistance (AMR) poses a global health threat, causing millions of deaths annually, with expectations of increased impact in the future. Wastewater surveillance offers a cost-effective, non-invasive tool to understand AMR carriage trends within a population. We monitored extended-spectrum β-lactamase producing Escherichia coli (ESBL-E. coli) weekly in influent wastewater from six wastewater treatment plants (WWTPs) in Switzerland (November 2021 to November 2022) to investigate spatio-temporal variations, explore correlations with environmental variables, develop a predictive model for ESBL-E. coli carriage in the community, and detect the most prevalent ESBL-genes. We cultured total and ESBL-E. coli in 300 wastewater samples to quantify daily loads and percentage of ESBL-E. coli. Additionally, we screened 234 ESBL-E. coli isolates using molecular methods for the presence of 18 ESBL-gene families. We found a population-weighted mean percentage of ESBL-E. coli of 1.9% (95% confidence interval: 1.8-2%) across all sites and weeks, which can inform ESBL-E. coli carriage. Concentrations of ESBL-E. coli varied across WWTPs and time, with higher values observed in WWTPs serving larger populations. Recent precipitations (previous 24/96 h) showed no significant association with ESBL-E. coli, while temperature occasionally had a moderate impact (P < 0.05, correlation coefficients approximately 0.40) in some locations. We identified blaCTX-M-1, blaCTX-M-9, and blaTEM as the predominant ESBL-gene families. Our study demonstrates that wastewater-based surveillance of culturable ESBL-E. coli provides insights into AMR trends in Switzerland and may also inform resistance. These findings establish a foundation for long term, nationally established monitoring protocols and provide information that may help inform targeted public health interventions. IMPORTANCE Antimicrobial resistance (AMR) is a global health threat and is commonly monitored in clinical settings, given its association with the risk of antimicrobial-resistant infections. Nevertheless, tracking AMR within a community proves challenging due to the substantial sample size required for a representative population, along with high associated costs and privacy concerns. By investigating high resolution temporal and geographic trends in extended-spectrum beta-lactamase producing Escherichia coli in wastewater, we provide an alternative approach to monitor AMR dynamics, distinct from the conventional clinical settings focus. Through this approach, we develop a mechanistic model, shedding light on the relationship between wastewater indicators and AMR carriage in the population. This perspective contributes valuable insights into trends of AMR carriage, emphasizing the importance of wastewater surveillance in informing effective public health interventions.
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Affiliation(s)
- Sheena Conforti
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
- Swiss Institute of Bioinformatics (SIB), Basel, Switzerland
| | - Aurélie Holschneider
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Émile Sylvestre
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Timothy R Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Khanal S, K C S, Joshi TP, Han Z, Wang C, Maharjan J, Tuladhar R, Joshi DR. Extended-spectrum β-lactamase-producing bacteria and their resistance determinants in different wastewaters and rivers in Nepal. JOURNAL OF HAZARDOUS MATERIALS 2024; 473:134660. [PMID: 38795483 DOI: 10.1016/j.jhazmat.2024.134660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 04/22/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
Wastewaters serve as significant reservoirs of antibiotic resistant bacteria. Despite the evidence of antimicrobial resistance in wastewaters and river water in Kathmandu, direct linkage between them is not discussed yet. This study investigated the prevalence of extended-spectrum β-lactamase (ESBL)-producing bacteria and associated resistance genes in wastewaters and river water. Out of 246 bacteria from wastewaters, 57.72% were ESBL producers and 77.64% of them were multidrug resistant (MDR). ESBL producing E. coli was dominant in municipal and hospital wastewaters (HWW) as well as in river water while K. pneumoniae was common in pharmaceutical wastewater. The blaSHV and blaTEM genes were prevalent and commonly co-occurred with aac(6')-Ib-cr in K. pneumoniae isolated pharmaceutical wastewater. blaCTX-M carrying E. coli from hospital co-harbored aac(6')-Ib-cr while that from municipal influent and river water co-harbored qnrS. Whole genome sequencing data revealed the presence of diverse ARGs in bacterial isolates against multiple antibiotics. In average, an E. coli and a K. pneumoniae isolate contained 55.75 ± 0.96 and 40.2 ± 5.36 ARGs, respectively. Multi-locus sequence typing showed the presence of globally high-risk clones with wider host range such as E. coli ST10, and K. pneumoniae ST15 and ST307 in HWW and river indicating frequent dissemination of antimicrobial resistance in wastewater of Kathmandu. Whole genome sequence data aligned with phenotypic antibiograms and resistance genes detected by PCR in selected isolates. The presence of significant plasmid replicons (IncF, IncY) and mobile genetic elements (IS903, IS26) indicate high frequency of spreading antibiotic resistance. These findings indicate burden and dissemination of antimicrobial resistance in the environment and highlight the need for effective strategies to mitigate the antibiotic resistance.
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Affiliation(s)
- Santosh Khanal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal; Environment Research Laboratory, Faculty of Science, Nepal Academy of Science and Technology, Lalitpur, Nepal; Department of Microbiology, Tri-Chandra Multiple Campus, Tribhuvan University, Kathmandu, Nepal
| | - Sudeep K C
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal; Environment Research Laboratory, Faculty of Science, Nepal Academy of Science and Technology, Lalitpur, Nepal
| | - Tista Prasai Joshi
- Environment Research Laboratory, Faculty of Science, Nepal Academy of Science and Technology, Lalitpur, Nepal
| | - Ziming Han
- National Engineering Research Center of Industrial Wastewater Detoxication and Resource Recovery, Research Center for Eco-Environmental Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Chunzhen Wang
- National Engineering Research Center of Industrial Wastewater Detoxication and Resource Recovery, Research Center for Eco-Environmental Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Jyoti Maharjan
- Molecular Biotechnology, Faculty of Science, Nepal Academy of Science and Technology, Lalitpur, Nepal
| | - Reshma Tuladhar
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Dev Raj Joshi
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
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Tiwari A, Krolicka A, Tran TT, Räisänen K, Ásmundsdóttir ÁM, Wikmark OG, Lood R, Pitkänen T. Antibiotic resistance monitoring in wastewater in the Nordic countries: A systematic review. ENVIRONMENTAL RESEARCH 2024; 246:118052. [PMID: 38163547 DOI: 10.1016/j.envres.2023.118052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
The Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) have effectively kept lower antibiotic-resistant bacterial (ARB) pathogen rates than many other countries. However, in recent years, these five countries have encountered a rise in ARB cases and challenges in treating infections due to the growing prevalence of ARB pathogens. Wastewater-based surveillance (WBS) is a valuable supplement to clinical methods for ARB surveillance, but there is a lack of comprehensive understanding of WBS application for ARB in the Nordic countries. This review aims to compile the latest state-of-the-art developments in WBS for ARB monitoring in the Nordic countries and compare them with clinical surveillance practices. After reviewing 1480 papers from the primary search, 54 were found relevant, and 15 additional WBS-related papers were included. Among 69 studies analyzed, 42 dedicated clinical epidemiology, while 27 focused on wastewater monitoring. The PRISMA review of the literature revealed that Nordic countries focus on four major WBS objectives of ARB: assessing ARB in the human population, identifying ARB evading wastewater treatment, quantifying removal rates, and evaluating potential ARB evolution during the treatment process. In both clinical and wastewater contexts, the most studied targets were pathogens producing carbapenemase and extended-spectrum beta-lactamase (ESBL), primarily Escherichia coli and Klebsiella spp. However, vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have received more attention in clinical epidemiology than in wastewater studies, probably due to their lower detection rates in wastewater. Clinical surveillance has mostly used culturing, antibiotic susceptibility testing, and genotyping, but WBS employed PCR-based and metagenomics alongside culture-based techniques. Imported cases resulting from international travel and hospitalization abroad appear to have frequently contributed to the rise in ARB pathogen cases in these countries. The many similarities between the Nordic countries (e.g., knowledge exchange practices, antibiotic usage patterns, and the current ARB landscape) could facilitate collaborative efforts in developing and implementing WBS for ARB in population-level screening.
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Affiliation(s)
- Ananda Tiwari
- Expert Microbiology Unit, Finnish Institute for Health and Welfare, 70701, Kuopio, Finland.
| | - Adriana Krolicka
- Norwegian Research Centre AS (NORCE), Nygårdstangen, 5838, Bergen, Norway
| | - Tam T Tran
- Norwegian Research Centre AS (NORCE), Nygårdstangen, 5838, Bergen, Norway
| | - Kati Räisänen
- Expert Microbiology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Odd-Gunnar Wikmark
- Norwegian Research Centre AS (NORCE), Nygårdstangen, 5838, Bergen, Norway; Unit for Environmental Science and Management, North West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Rolf Lood
- Department of Clinical Sciences Lund, Division of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Tarja Pitkänen
- Expert Microbiology Unit, Finnish Institute for Health and Welfare, 70701, Kuopio, Finland; Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland.
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Bobis Camacho J, Nilsson J, Larsson DGJ, Flach CF. Evaluation of culture conditions for sewage-based surveillance of antibiotic resistance in Klebsiella pneumoniae. J Glob Antimicrob Resist 2024; 37:122-128. [PMID: 38552871 DOI: 10.1016/j.jgar.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/24/2024] [Accepted: 03/09/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Recent studies have shown promise in predicting clinical antibiotic resistance rates from sewage data. Few have focused on Klebsiella pneumoniae, despite its virulence and importance as carrier of antibiotic resistance. Several media have been suggested for the isolation of K. pneumoniae from complex samples. However, comprehensive evaluations of culture protocols for isolation of K. pneumoniae from sewage are lacking. METHODS Here, influent samples from a major Swedish sewage treatment plant were used to evaluate ten culture conditions in parallel: cultivation on Brilliant green containing Inositol-Nitrate-Deoxycholate agar (BIND), Bruce agar, Klebsiella ChromoSelect Selective agar®, MacConkey-Inositol-Carbenicillin, or Simmons Citrate Agar with Inositol (SCAI) incubated at either 37°C or 42°C for 44 h. The culture conditions were compared based on colony counts of presumed K. pneumoniae and identification precision assessed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. RESULTS The sensitivity was lowest for BIND, whereas it was similar for the other media irrespective of incubation temperature. For four media, a better precision was observed after incubation at 42°C compared to 37°C, to a large extent explained by a lower frequency of captured Klebsiella oxytoca. SCAI incubated at 42°C showed the highest precision (84.4%). By combining this protocol with subsequent antibiotic resistance screening of collected isolates, low resistance rates in sewage K. pneumoniae were revealed, potentially reflecting the local resistance landscape. CONCLUSION When combined with downstream analyses, SCAI incubated at 42°C could be a valuable culture protocol for sewage-based studies on various aspects of K. pneumoniae epidemiology including antibiotic resistance prevalence.
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Affiliation(s)
- Julián Bobis Camacho
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Johanna Nilsson
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Dan Göran Joakim Larsson
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Carl-Fredrik Flach
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
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Gholipour S, Shamsizadeh Z, Halabowski D, Gwenzi W, Nikaeen M. Combating antibiotic resistance using wastewater surveillance: Significance, applications, challenges, and future directions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 908:168056. [PMID: 37914125 DOI: 10.1016/j.scitotenv.2023.168056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023]
Abstract
The global increase of antibiotic resistance (AR) and resistant infections call for effective surveillance methods for understanding and mitigating (re)-emerging public health risks. Wastewater surveillance (WS) of antibiotic resistance is an emerging, but currently under-utilized decision-support tool in public health systems. Recent years have witnessed an increase in evidence linking antibiotic resistance in wastewaters to that of the community. To date, very few comprehensive reviews exist on the application of WS to understand AR and resistant infections in population. Current and emerging AR detection methods, and their merits and limitations are discussed. Wastewater surveillance has several merits relative to individual testing, including; (1) low per capita testing cost, (2) high spatial coverage, (3) low requirement for diagnostic equipment, and (4) detection of health threats ahead of real outbreaks. The applications of WS as an early warning system and decision support tool to understand and mitigate AR are discussed. Wastewater surveillance could be a tool of choice in low-income settings lacking resources and diagnostic facilities for individual testing. To demonstrate the utility of WS, empirical evidence from field case studies is presented. However, constraints still exist, including; (1) lack of standardized protocols, (2) the clinical utility and sensitivity of WS-based data, (3) uncertainties in relating WS data to pathogenic and virulent bacteria, and (4) whether or not AR in stools and ultimately wastewater represent the complete human resistome. Finally, further prospects are presented, include knowledge gaps on; (1) development of low-cost biosensors for AR, (2) development of WS protocols (sampling, processing, interpretation), (3) further pilot scale studies to understand the opportunities and limits of WS, and (4) development of computer-based analytical tools to facilitate rapid data collection, visualization and interpretation. Therefore, the present paper discusses the principles, opportunities, and constraints of wastewater surveillance applications to understand AR and safeguard public health.
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Affiliation(s)
- Sahar Gholipour
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Shamsizadeh
- Department of Environmental Health Engineering, School of Health, Larestan University of Medical Sciences, Larestan, Iran
| | - Dariusz Halabowski
- University of Lodz, Faculty of Biology and Environmental Protection, Department of Ecology and Vertebrate Zoology, Lodz, Poland
| | - Willis Gwenzi
- Universität Kassel, Fachbereich Ökologische Agrarwissenschaften Fachgebiet Grünlandwissenschaft und Nachwachsende Rohstoffe, Steinstr. 19, 37249 Witzenhausen, Germany; Leibniz-Institut für Agrartechnik und Bioökonomie e.V. Max-Eyth-Allee 100, D-14469 Potsdam, Germany.
| | - Mahnaz Nikaeen
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran.
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Yu Z, He W, Klincke F, Madsen JS, Kot W, Hansen LH, Quintela-Baluja M, Balboa S, Dechesne A, Smets B, Nesme J, Sørensen SJ. Insights into the circular: The cryptic plasmidome and its derived antibiotic resistome in the urban water systems. ENVIRONMENT INTERNATIONAL 2024; 183:108351. [PMID: 38041983 DOI: 10.1016/j.envint.2023.108351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023]
Abstract
Plasmids have been a concern in the dissemination and evolution of antibiotic resistance in the environment. In this study, we investigated the total pool of plasmids (plasmidome) and its derived antibiotic resistance genes (ARGs) in different compartments of urban water systems (UWSs) in three European countries representing different antibiotic usage regimes. We applied a direct plasmidome approach using wet-lab methods to enrich circular DNA in the samples, followed by shotgun sequencing and in silico contig circularisation. We identified 9538 novel sequences in a total of 10,942 recovered circular plasmids. Of these, 66 were identified as conjugative, 1896 mobilisable and 8970 non-mobilisable plasmids. The UWSs' plasmidome was dominated by small plasmids (≤10 Kbp) representing a broad diversity of mobility (MOB) types and incompatibility (Inc) groups. A shared collection of plasmids from different countries was detected in all treatment compartments, and plasmids could be source-tracked in the UWSs. More than half of the ARGs-encoding plasmids carried mobility genes for mobilisation/conjugation. The richness and abundance of ARGs-encoding plasmids generally decreased with the flow, while we observed that non-mobilisable ARGs-harbouring plasmids maintained their abundance in the Spanish wastewater treatment plant. Overall, our work unravels that the UWS plasmidome is dominated by cryptic (i.e., non-mobilisable, non-typeable and previously unknown) plasmids. Considering that some of these plasmids carried ARGs, were prevalent across three countries and could persist throughout the UWSs compartments, these results should alarm and call for attention.
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Affiliation(s)
- Zhuofeng Yu
- Section of Microbiology, University of Copenhagen, Universitetsparken 15, DK-2100 Copenhagen, Denmark
| | - Wanli He
- Section of Microbiology, University of Copenhagen, Universitetsparken 15, DK-2100 Copenhagen, Denmark
| | - Franziska Klincke
- Section of Microbiology, University of Copenhagen, Universitetsparken 15, DK-2100 Copenhagen, Denmark
| | - Jonas Stenløkke Madsen
- Section of Microbiology, University of Copenhagen, Universitetsparken 15, DK-2100 Copenhagen, Denmark
| | - Witold Kot
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark; Department of Plant and Environmental Science, University of Copenhagen, Thorvaldsensvej 40, DK-1871 Frederiksberg, Denmark
| | - Lars Hestbjerg Hansen
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark; Department of Plant and Environmental Science, University of Copenhagen, Thorvaldsensvej 40, DK-1871 Frederiksberg, Denmark
| | - Marcos Quintela-Baluja
- Department of Microbiology and Parasitology, University of Santiago de Compostela, Praza do Obradoiro, 0, 15705 Santiago de Compostela, A Coruña, Spain
| | - Sabela Balboa
- School of Engineering, Newcastle University, NE1 7RX Newcastle upon Tyne, United Kingdom
| | - Arnaud Dechesne
- Department of Environmental Engineering, Technical University of Denmark, Bygningstorvet 115, DK-2800 Kgs. Lyngby, Denmark
| | - Barth Smets
- Department of Environmental Engineering, Technical University of Denmark, Bygningstorvet 115, DK-2800 Kgs. Lyngby, Denmark
| | - Joseph Nesme
- Section of Microbiology, University of Copenhagen, Universitetsparken 15, DK-2100 Copenhagen, Denmark.
| | - Søren Johannes Sørensen
- Section of Microbiology, University of Copenhagen, Universitetsparken 15, DK-2100 Copenhagen, Denmark.
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Gomi R, Matsumura Y, Yamamoto M, Tanaka M, Komakech AJ, Matsuda T, Harada H. Genomic surveillance of antimicrobial-resistant Escherichia coli in fecal sludge and sewage in Uganda. WATER RESEARCH 2024; 248:120830. [PMID: 37979567 DOI: 10.1016/j.watres.2023.120830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
Abstract
The global increase of antimicrobial resistance (AMR) is a major public health concern. An effective AMR surveillance tool is needed to track the emergence and spread of AMR. Wastewater surveillance has been proposed as a resource-efficient tool for monitoring AMR carriage in the community. Here, we performed genomic surveillance of antimicrobial-resistant Escherichia coli obtained from fecal sludge and sewage in Uganda to gain insights into E. coli epidemiology and AMR burden in the underlying population. Selective media containing different antibiotic combinations (cefotaxime, ciprofloxacin, cefotaxime + ciprofloxacin + gentamicin) were used to obtain antimicrobial-resistant E. coli from fecal sludge and sewage. Short-read sequencing was performed for the obtained isolates, and a subset of isolates (selected from predominant sequence types (STs)) was also subjected to long-read sequencing. Genomic analysis of the obtained E. coli isolates (n = 181) revealed the prevalence of clonal complex 10, including ST167 (n = 43), ST10 (n = 28), ST1284 (n = 17), and ST617 (n = 4), in both fecal sludge and sewage, irrespective of antibiotics used for selection. We also detected global high-risk clones ST1193 (n = 10) and ST131 (n = 2 clade A, n = 3 subclade C1-M27, and n = 1 subclade C2). Diverse AMR determinants, including extended-spectrum β-lactamase genes (mostly blaCTX-M-15) and mutations in gyrA and parC, were identified. Analysis of the completed genomes revealed that diverse IncF plasmids and chromosomal integration were the major contributors to the spread of AMR genes in the predominant STs. This study showed that a combination of sewage surveillance (or fecal sludge surveillance) and whole-genome sequencing can be a powerful tool for monitoring AMR carriage in the underlying population.
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Affiliation(s)
- Ryota Gomi
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Katsura, Nishikyo-ku, Kyoto 615-8540, Japan.
| | - Yasufumi Matsumura
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masaki Yamamoto
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Mai Tanaka
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Katsura, Nishikyo-ku, Kyoto 615-8540, Japan
| | - Allan John Komakech
- Department of Agricultural and Biosystems Engineering, College of Agricultural and Environmental Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Tomonari Matsuda
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Katsura, Nishikyo-ku, Kyoto 615-8540, Japan
| | - Hidenori Harada
- Graduate School of Asian and African Area Studies, Kyoto University, Yoshida-Shimoadachi, Sakyo-ku, Kyoto 606-8501, Japan.
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Gholizadeh A, Khiadani M, Foroughi M, Alizade Siuki H, Mehrfar H. Wastewater treatment plants: The missing link in global One-Health surveillance and management of antibiotic resistance. J Infect Public Health 2023; 16 Suppl 1:217-224. [PMID: 37865529 DOI: 10.1016/j.jiph.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION As a global public health crisis, antibiotic resistance (AR) should be monitored and managed under the One-Health concept according to the World Health Organization (WHO), considering the interconnection between humans, animals, and the environment. But this approach often remains focused on human health and rarely on the environment and its compartments, especially wastewater as the main AR receptor. Wastewater treatment plants (WWTPs) not only are not designed for reliving AR but also provide appropriate conditions for enhancing AR through different mechanisms. METHODS By reviewing the research-based statistics on the inclusion of WWTPs in the One-Health/AR program crisis, this paper highlights the importance of paying attention to these hotspots, at first. Also, the importance and technical roadmap for the application of WWTPs in both surveillance and management of AR were provided. The current position of these facilities was also evaluated using strengths, weaknesses, opportunities, and threats (SWOT) analysis. In the end, the concluding knowledge gaps and research needs for future investigations were presented. RESULTS Despite the fact that wastewater matrices are the hotspot for AR dissemination, WWTPs appear under-represented in One-Health/AR literature. So, of the 414434 articles retrieved for One-Health only 1.5% (n = 6321) focused on AR and about 0.04% (n = 158) on WWTPs. The potential of WWTPs inclusion in AR surveillance has been confirmed by several studies, however, when it comes to its inclusion for management of AR, more evidence should be presented, which confirmed by SWOT results. DISCUSSION As such, WWTPs simultaneously provide opportunities for AR surveillance as it is assumed that this medium can reflect the reality of the corresponding society, and for managing unexpected crises which could impact the public. Nonetheless, there are still numerous considerations to change WWTPs role from Achilles' heel to Ajax' shield, including strengthening the research-based knowledge and conducting both surveillance and management strategies of AR under One-Health concept (One-Health/AR) in a clear straightforward framework.
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Affiliation(s)
- Abdolmajid Gholizadeh
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mehdi Khiadani
- School of Engineering, Edith Cowan University, Joondalup, Perth WA, Australia
| | - Maryam Foroughi
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Hadi Alizade Siuki
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Hadi Mehrfar
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
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Lepper HC, Perry MR, Wee BA, Wills D, Nielsen H, Otani S, Simon M, Aarestrup FM, Woolhouse MEJ, van Bunnik BAD. Distinctive hospital and community resistomes in Scottish urban wastewater: Metagenomics of a paired wastewater sampling design. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 902:165978. [PMID: 37544442 DOI: 10.1016/j.scitotenv.2023.165978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/26/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
The wastewater microbiome contains a multitude of resistant bacteria of human origin, presenting an opportunity for surveillance of resistance in the general population. However, wastewater microbial communities are also influenced by clinical sources, such as hospitals. Identifying signatures of the community and hospital resistome in wastewater is needed for interpretation and risk analysis. In this study, we compare the resistome and microbiome of hospital, community, and mixed municipal wastewater to investigate how and why the composition of these different sites differ. We conducted shotgun metagenomic analysis on wastewater samples from eight wastewater treatment plants (WWTPs), four hospitals, and four community sites in Scotland, using a paired sampling design. Cluster analysis and source attribution random forest models demonstrated that the hospital resistome was distinct from community and WWTP resistomes. Hospital wastewater had a higher abundance and diversity of resistance genes, in keeping with evidence that hospitals act as a reservoir and enricher of resistance. However, this distinctive 'hospital' signature appeared to be weak in the resistome of downstream WWTPs, likely due to dilution. We conclude that hospital and community wastewater resistomes differ, with the hospital wastewater representing a reservoir of patient- and hospital environment-associated bacteria. However, this 'hospital' signature is transient and does not overwhelm the community signature in the resistome of the downstream WWTP influent.
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Affiliation(s)
- Hannah C Lepper
- Usher Institute, University of Edinburgh, Ashworth Laboratories, Charlotte Auerbach Road, Edinburgh EH9 3FL, United Kingdom.
| | - Meghan R Perry
- Usher Institute, University of Edinburgh, Ashworth Laboratories, Charlotte Auerbach Road, Edinburgh EH9 3FL, United Kingdom; Clinical Infection Research Group, NHS Lothian Infection Service, Edinburgh, United Kingdom.
| | - Bryan A Wee
- Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, United Kingdom.
| | - David Wills
- Scottish Water, Currie, Edinburgh EH14 4AP, United Kingdom.
| | - Hanne Nielsen
- National Food Institute, The Technical University of Denmark, Kemitorvet Bygning 202, 2800 Kongens Lyngby, Denmark.
| | - Saria Otani
- National Food Institute, The Technical University of Denmark, Kemitorvet Bygning 202, 2800 Kongens Lyngby, Denmark.
| | - Moray Simon
- Scottish Water, Currie, Edinburgh EH14 4AP, United Kingdom.
| | - Frank M Aarestrup
- National Food Institute, The Technical University of Denmark, Kemitorvet Bygning 202, 2800 Kongens Lyngby, Denmark.
| | - Mark E J Woolhouse
- Usher Institute, University of Edinburgh, Ashworth Laboratories, Charlotte Auerbach Road, Edinburgh EH9 3FL, United Kingdom.
| | - Bram A D van Bunnik
- Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, United Kingdom.
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10
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Kuhn KG, Shukla R, Mannell M, Graves GM, Miller AC, Vogel J, Malloy K, Deshpande G, Florea G, Shelton K, Jeffries E, De León KB, Stevenson B. Using Wastewater Surveillance to Monitor Gastrointestinal Pathogen Infections in the State of Oklahoma. Microorganisms 2023; 11:2193. [PMID: 37764037 PMCID: PMC10536226 DOI: 10.3390/microorganisms11092193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
During the COVID-19 pandemic, wastewater surveillance was widely used to monitor temporal and geographical infection trends. Using this as a foundation, a statewide program for routine wastewater monitoring of gastrointestinal pathogens was established in Oklahoma. The results from 18 months of surveillance showed that wastewater concentrations of Salmonella, Campylobacter, and norovirus exhibit similar seasonal patterns to those observed in reported human cases (F = 4-29, p < 0.05) and that wastewater can serve as an early warning tool for increases in cases, offering between one- and two-weeks lead time. Approximately one third of outbreak alerts in wastewater correlated in time with confirmed outbreaks of Salmonella or Campylobacter and our results further indicated that several outbreaks are likely to go undetected through the traditional surveillance approach currently in place. Better understanding of the true distribution and burden of gastrointestinal infections ultimately facilitates better disease prevention and control and reduces the overall socioeconomic and healthcare related impact of these pathogens. In this respect, wastewater represents a unique opportunity for monitoring infections in real-time, without the need for individual human testing. With increasing demands for sustainable and low-cost disease surveillance, the usefulness of wastewater as a long-term method for tracking infectious disease transmission is likely to become even more pronounced.
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Affiliation(s)
- Katrin Gaardbo Kuhn
- Department of Biostatistics & Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (K.M.); (G.D.)
| | - Rishabh Shukla
- School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, OK 73019, USA; (R.S.); (G.M.G.); (A.C.M.); (J.V.); (G.F.)
| | - Mike Mannell
- Acute Diseases Division, Oklahoma State Department of Health, Oklahoma City, OK 73102, USA;
| | - Grant M. Graves
- School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, OK 73019, USA; (R.S.); (G.M.G.); (A.C.M.); (J.V.); (G.F.)
| | - A. Caitlin Miller
- School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, OK 73019, USA; (R.S.); (G.M.G.); (A.C.M.); (J.V.); (G.F.)
| | - Jason Vogel
- School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, OK 73019, USA; (R.S.); (G.M.G.); (A.C.M.); (J.V.); (G.F.)
| | - Kimberly Malloy
- Department of Biostatistics & Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (K.M.); (G.D.)
| | - Gargi Deshpande
- Department of Biostatistics & Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (K.M.); (G.D.)
| | - Gabriel Florea
- School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, OK 73019, USA; (R.S.); (G.M.G.); (A.C.M.); (J.V.); (G.F.)
- Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Kristen Shelton
- School of Biological Sciences, University of Oklahoma, Norman, OK 73019, USA; (K.S.); (E.J.); (K.B.D.L.)
| | - Erin Jeffries
- School of Biological Sciences, University of Oklahoma, Norman, OK 73019, USA; (K.S.); (E.J.); (K.B.D.L.)
| | - Kara B. De León
- School of Biological Sciences, University of Oklahoma, Norman, OK 73019, USA; (K.S.); (E.J.); (K.B.D.L.)
| | - Bradley Stevenson
- Department of Earth and Planetary Sciences, Northwestern University, Evanston, IL 60208, USA;
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11
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Bengtsson-Palme J, Abramova A, Berendonk TU, Coelho LP, Forslund SK, Gschwind R, Heikinheimo A, Jarquín-Díaz VH, Khan AA, Klümper U, Löber U, Nekoro M, Osińska AD, Ugarcina Perovic S, Pitkänen T, Rødland EK, Ruppé E, Wasteson Y, Wester AL, Zahra R. Towards monitoring of antimicrobial resistance in the environment: For what reasons, how to implement it, and what are the data needs? ENVIRONMENT INTERNATIONAL 2023; 178:108089. [PMID: 37441817 DOI: 10.1016/j.envint.2023.108089] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
Antimicrobial resistance (AMR) is a global threat to human and animal health and well-being. To understand AMR dynamics, it is important to monitor resistant bacteria and resistance genes in all relevant settings. However, while monitoring of AMR has been implemented in clinical and veterinary settings, comprehensive monitoring of AMR in the environment is almost completely lacking. Yet, the environmental dimension of AMR is critical for understanding the dissemination routes and selection of resistant microorganisms, as well as the human health risks related to environmental AMR. Here, we outline important knowledge gaps that impede implementation of environmental AMR monitoring. These include lack of knowledge of the 'normal' background levels of environmental AMR, definition of high-risk environments for transmission, and a poor understanding of the concentrations of antibiotics and other chemical agents that promote resistance selection. Furthermore, there is a lack of methods to detect resistance genes that are not already circulating among pathogens. We conclude that these knowledge gaps need to be addressed before routine monitoring for AMR in the environment can be implemented on a large scale. Yet, AMR monitoring data bridging different sectors is needed in order to fill these knowledge gaps, which means that some level of national, regional and global AMR surveillance in the environment must happen even without all scientific questions answered. With the possibilities opened up by rapidly advancing technologies, it is time to fill these knowledge gaps. Doing so will allow for specific actions against environmental AMR development and spread to pathogens and thereby safeguard the health and wellbeing of humans and animals.
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Affiliation(s)
- Johan Bengtsson-Palme
- Division of Systems and Synthetic Biology, Department of Life Sciences, SciLifeLab, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10, SE-413 46 Gothenburg, Sweden; Centre for Antibiotic Resistance Research (CARe) in Gothenburg, Sweden.
| | - Anna Abramova
- Division of Systems and Synthetic Biology, Department of Life Sciences, SciLifeLab, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10, SE-413 46 Gothenburg, Sweden; Centre for Antibiotic Resistance Research (CARe) in Gothenburg, Sweden
| | - Thomas U Berendonk
- Institute of Hydrobiology, Technische Universität Dresden, Zellescher Weg 40, 01217 Dresden, Germany
| | - Luis Pedro Coelho
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Sofia K Forslund
- Experimental and Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Rémi Gschwind
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME F-75018 Paris, France
| | - Annamari Heikinheimo
- University of Helsinki, Faculty of Veterinary Medicine, Department of Food Hygiene and Environmental Health, P.O.Box 66, FI-00014, Finland; Finnish Food Authority, P.O.Box 100, 00027 Seinäjoki, Finland
| | - Víctor Hugo Jarquín-Díaz
- Experimental and Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Ayaz Ali Khan
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan; Department of Biotechnology, University of Malakand, Chakdara, Dir (Lower), Khyber Pakhtunkhwa, Pakistan
| | - Uli Klümper
- Institute of Hydrobiology, Technische Universität Dresden, Zellescher Weg 40, 01217 Dresden, Germany
| | - Ulrike Löber
- Experimental and Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Marmar Nekoro
- Swedish Knowledge Centre on Pharmaceuticals in the Environment, Swedish Medical Products Agency, P.O Box 26, 751 03 Uppsala, Sweden
| | - Adriana D Osińska
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Department of Paraclinical Sciences, P.O.Box 5003 NMBU, N-1432 Ås, Norway
| | - Svetlana Ugarcina Perovic
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Tarja Pitkänen
- University of Helsinki, Faculty of Veterinary Medicine, Department of Food Hygiene and Environmental Health, P.O.Box 66, FI-00014, Finland; Finnish Institute for Health and Welfare, Expert Microbiology Unit, P.O.Box 95, FI-70701 Kuopio, Finland
| | | | - Etienne Ruppé
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME F-75018 Paris, France
| | - Yngvild Wasteson
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Department of Paraclinical Sciences, P.O.Box 5003 NMBU, N-1432 Ås, Norway
| | | | - Rabaab Zahra
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan
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12
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Verlicchi P, Grillini V, Lacasa E, Archer E, Krzeminski P, Gomes AI, Vilar VJP, Rodrigo MA, Gäbler J, Schäfer L. Selection of indicator contaminants of emerging concern when reusing reclaimed water for irrigation - A proposed methodology. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 873:162359. [PMID: 36822429 DOI: 10.1016/j.scitotenv.2023.162359] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Organic and microbial contaminants of emerging concern (CECs), even though not yet regulated, are of great concern in reclaimed water reuse projects. Due to the large number of CECs and their different characteristics, it is useful to include only a limited number of them in monitoring programs. The selection of the most representative CECs is still a current and open question. This study presents a new methodology for this scope, in particular for the evaluation of the performance of a polishing treatment and the assessment of the risk for the environment and the irrigated crops. As to organic CECs, the methodology is based on four criteria (occurrence, persistence, bioaccumulation and toxicity) expressed in terms of surrogates (respectively, concentrations in the secondary effluent, removal achieved in conventional activated sludge systems, Log Kow and predicted-no-effect concentration). It consists of: (i) development of a dataset including the CECs found in the secondary effluent, together with the corresponding values of surrogates found in the literature or by in-field investigations; (ii) normalization step with the assignment of a score between 1 (low environmental impact) and 5 (high environmental impact) to the different criteria based on threshold values set according to the literature and experts' judgement; (iii) CEC ranking according to their final score obtained as the sum of the specific scores; and (iv) selection of the representative CECs for the different needs. Regarding microbial CECs, the selection is based on their occurrence and their highest detection frequency in the secondary effluent and in the receiving water, the antibiotic consumption patterns, and recommendations by national and international organisations. The methodology was applied within the ongoing reuse project SERPIC resulting in a list of 30 indicator CECs, including amoxicillin, bisphenol A, ciprofloxacin, diclofenac, erythromycin, ibuprofen, iopromide, perfluorooctane sulfonate (PFOS), sulfamethoxazole, tetracycline, Escherichia coli, faecal coliform, 16S rRNA, sul1, and sul2.
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Affiliation(s)
- P Verlicchi
- Department of Engineering, University of Ferrara, Via Saragat 1, 44121 Ferrara, Italy.
| | - V Grillini
- Department of Engineering, University of Ferrara, Via Saragat 1, 44121 Ferrara, Italy.
| | - E Lacasa
- Department of Chemical Engineering, University of Castilla-La Mancha, Campus Universitario s/n, Albacete, 02071, Spain.
| | - E Archer
- Department of Microbiology, Stellenbosch University, Stellenbosch 7600, South Africa.
| | - P Krzeminski
- Norwegian Institute for Water Research (NIVA), Urban Environments and Infrastructure Section, Økernveien 94, N-0579 Oslo, Norway.
| | - A I Gomes
- Laboratory of Separation and Reaction Engineering-Laboratory of Catalysis and Materials (LSRE-LCM), Departamento de Engenharia Química, Faculdade de Engenharia da Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; Associate Laboratory in Chemical Engineering (ALiCE), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal.
| | - V J P Vilar
- Laboratory of Separation and Reaction Engineering-Laboratory of Catalysis and Materials (LSRE-LCM), Departamento de Engenharia Química, Faculdade de Engenharia da Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; Associate Laboratory in Chemical Engineering (ALiCE), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal.
| | - M A Rodrigo
- Departamento de Ingeniería Química, Universidad de Castilla-La Mancha, Ciudad Real, Spain.
| | - J Gäbler
- Fraunhofer Institute for Surface Engineering and Thin Films IST, 38108 Braunschweig, Germany.
| | - L Schäfer
- Fraunhofer Institute for Surface Engineering and Thin Films IST, 38108 Braunschweig, Germany.
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13
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Larsson DGJ, Flach CF, Laxminarayan R. Sewage surveillance of antibiotic resistance holds both opportunities and challenges. Nat Rev Microbiol 2023; 21:213-214. [PMID: 36470999 PMCID: PMC9734844 DOI: 10.1038/s41579-022-00835-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
Sewage surveillance could provide information on the resistance situation in the underlying population and on environmental transmission risks. There are opportunities to make such surveillance data more informative and actionable, but there are also challenges.
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Affiliation(s)
- D G Joakim Larsson
- Department of Infectious Diseases, Institute for Biomedicine, University of Gothenburg, Gothenburg, Sweden. .,Centre for Antibiotic Resistance Research at University of Gothenburg, Gothenburg, Sweden.
| | - Carl-Fredrik Flach
- Department of Infectious Diseases, Institute for Biomedicine, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research at University of Gothenburg, Gothenburg, Sweden
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14
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Huijbers PMC, Bobis Camacho J, Hutinel M, Larsson DGJ, Flach CF. Sampling Considerations for Wastewater Surveillance of Antibiotic Resistance in Fecal Bacteria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4555. [PMID: 36901565 PMCID: PMC10002399 DOI: 10.3390/ijerph20054555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Wastewaters can be analyzed to generate population-level data for public health surveillance, such as antibiotic resistance monitoring. To provide representative data for the contributing population, bacterial isolates collected from wastewater should originate from different individuals and not be distorted by a selection pressure in the wastewater. Here we use Escherichia coli diversity as a proxy for representativeness when comparing grab and composite sampling at a major municipal wastewater treatment plant influent and an untreated hospital effluent in Gothenburg, Sweden. All municipal samples showed high E. coli diversity irrespective of the sampling method. In contrast, a marked increase in diversity was seen for composite compared to grab samples from the hospital effluent. Virtual resampling also showed the value of collecting fewer isolates on multiple occasions rather than many isolates from a single sample. Time-kill tests where individual E. coli strains were exposed to sterile-filtered hospital wastewater showed rapid killing of antibiotic-susceptible strains and significant selection of multi-resistant strains when incubated at 20 °C, an effect which could be avoided at 4 °C. In conclusion, depending on the wastewater collection site, both sampling method and collection/storage temperature could significantly impact the representativeness of the wastewater sample.
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Affiliation(s)
- Patricia M. C. Huijbers
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, 40530 Gothenburg, Sweden
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Guldhedsgatan 10A, 40530 Gothenburg, Sweden
| | - Julián Bobis Camacho
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, 40530 Gothenburg, Sweden
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Guldhedsgatan 10A, 40530 Gothenburg, Sweden
| | - Marion Hutinel
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, 40530 Gothenburg, Sweden
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Guldhedsgatan 10A, 40530 Gothenburg, Sweden
| | - D. G. Joakim Larsson
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, 40530 Gothenburg, Sweden
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Guldhedsgatan 10A, 40530 Gothenburg, Sweden
| | - Carl-Fredrik Flach
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, 40530 Gothenburg, Sweden
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Guldhedsgatan 10A, 40530 Gothenburg, Sweden
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15
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Akram F, Imtiaz M, Haq IU. Emergent crisis of antibiotic resistance: A silent pandemic threat to 21 st century. Microb Pathog 2023; 174:105923. [PMID: 36526035 DOI: 10.1016/j.micpath.2022.105923] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
Antibiotic resistance has become an indispensably alarming menace to the global community. The primary factors are overuse and abuse of antibiotics, lack of novel medicines under development, the health care industry's focus on profit, and the absence of diagnostic testing prior to the prescription of antibiotics. Additionally, over the past few decades, the main factors contributing to the global spread of antibiotic resistance have been the overuse of antibiotics in livestock and other animals, drug efficacy, development of fewer new vaccines, environmental toxicity, transmission through travel, and lack of funding for healthcare research and development. These factors have accelerated resistance in microorganisms through structural and functional modifications in bacteria such as reduced drug permeability, increased efflux pumps, enzymatic antibiotic modification, and change in drug target, intracellular infection, and biofilm creation. There has been an increase in resistance during the pandemic and among cancer patients due to improper prescriptions. A number of modern therapeutic alternatives have been developed to curb widespread antibiotic resistance such as nanoparticle, bacteriophage, and antimicrobial biochemical approaches. It is high time to explore new alternatives to curtail enormous increase in resistant pathogens which could be an incurable global confrontation. This review highlights the complete insight on the global drivers of resistance along with the modes of action and impacts, finally discussing the latest therapeutic alternatives.
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Affiliation(s)
- Fatima Akram
- Institute of Industrial Biotechnology, Government College University, Lahore, 54000, Pakistan.
| | - Memoona Imtiaz
- Institute of Industrial Biotechnology, Government College University, Lahore, 54000, Pakistan
| | - Ikram Ul Haq
- Institute of Industrial Biotechnology, Government College University, Lahore, 54000, Pakistan; Pakistan Academy of Sciences, Islamabad, Pakistan
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16
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Tiwari A, Kurittu P, Al-Mustapha AI, Heljanko V, Johansson V, Thakali O, Mishra SK, Lehto KM, Lipponen A, Oikarinen S, Pitkänen T, Heikinheimo A. Wastewater surveillance of antibiotic-resistant bacterial pathogens: A systematic review. Front Microbiol 2022; 13:977106. [PMID: 36590429 PMCID: PMC9798455 DOI: 10.3389/fmicb.2022.977106] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Infectious diseases caused by antibiotic-resistant bacterial (ARB) pathogens are a serious threat to human and animal health. The active surveillance of ARB using an integrated one-health approach can help to reduce the emergence and spread of ARB, reduce the associated economic impact, and guide antimicrobial stewardship programs. Wastewater surveillance (WWS) of ARB provides composite samples for a total population, with easy access to the mixed community microbiome. This concept is emerging rapidly, but the clinical utility, sensitivity, and uniformity of WWS of ARB remain poorly understood especially in relation to clinical evidence in sewershed communities. Here, we systematically searched the literature to identify studies that have compared findings from WWS of ARB and antibiotic resistance genes (ARG) with clinical evidence in parallel, thereby evaluating how likely WWS of ARB and ARG can relate to the clinical cases in communities. Initially, 2,235 articles were obtained using the primary search keywords, and 1,219 articles remained after de-duplication. Among these, 35 articles fulfilled the search criteria, and an additional 13 relevant articles were included by searching references in the primary literature. Among the 48 included papers, 34 studies used a culture-based method, followed by 11 metagenomics, and three PCR-based methods. A total of 28 out of 48 included studies were conducted at the single sewershed level, eight studies involved several countries, seven studies were conducted at national or regional scales, and five at hospital levels. Our review revealed that the performance of WWS of ARB pathogens has been evaluated more frequently for Escherichia coli, Enterococcus spp., and other members of the family Enterobacteriaceae, but has not been uniformly tested for all ARB pathogens. Many wastewater-based ARB studies comparing the findings with clinical evidence were conducted to evaluate the public health risk but not to relate with clinical evidence and to evaluate the performance of WWS of ARB. Indeed, relating WWS of ARB with clinical evidence in a sewershed is not straightforward, as the source of ARB in wastewater cannot be only from symptomatic human individuals but can also be from asymptomatic carriers as well as from animal sources. Further, the varying fates of each bacterial species and ARG within the sewerage make the aim of connecting WWS of ARB with clinical evidence more complicated. Therefore, future studies evaluating the performance of many AMR pathogens and their genes for WWS one by one can make the process simpler and the interpretation of results easier.
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Affiliation(s)
- Ananda Tiwari
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland,*Correspondence: Ananda Tiwari,
| | - Paula Kurittu
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Ahmad I. Al-Mustapha
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland,Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria,Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Nigeria
| | - Viivi Heljanko
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Venla Johansson
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Ocean Thakali
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Shyam Kumar Mishra
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Kirsi-Maarit Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anssi Lipponen
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sami Oikarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tarja Pitkänen
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland,Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Annamari Heikinheimo
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland,Finnish Food Authority, Seinäjoki, Finland
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17
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Tabut P, Yongyod R, Ungcharoen R, Kerdsin A. The Distribution of Mobile Colistin-Resistant Genes, Carbapenemase-Encoding Genes, and Fluoroquinolone-Resistant Genes in Escherichia coli Isolated from Natural Water Sources in Upper Northeast Thailand. Antibiotics (Basel) 2022; 11:antibiotics11121760. [PMID: 36551417 PMCID: PMC9774790 DOI: 10.3390/antibiotics11121760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
Antimicrobial resistance (AMR) is considered a serious problem in many countries, including Thailand. AMR and antibiotic resistance genes (ARGs) could transfer between humans, animals, and the environment causing a threat to human health. This study described the antibiotic resistance of Escherichia coli (E. coli) from surface water, wastewater, and discharge water in the Namsuay watershed in upper northeast Thailand. The water samples were collected in the dry and wet seasons. The 113 E. coli isolates were confirmed using a polymerase chain reaction and examined for their antibiotic susceptibility, ARGs, and genetic relationship. The results indicated that E. coli was resistant to the following classes of antibiotics: fluoroquinolone, third-generation cephalosporin, polymyxin, and carbapenem. The isolates carried the mcr-1, mcr-8, mcr-9, blaoxa-48-like, aac(6')-bl-cr, qepA, and oqxAB genes. Phylogroup B1 was a predominant group among the E. coli in the study. In addition, the E. coli isolates from the discharge water (a hospital and a fish farm) had a higher prevalence of antibiotic resistance and harboured more ARGs than the other water sample sources. The presence of antibiotic-resistant E. coli and ARG contamination in the natural water source reflected an AMR management issue that could drive strategic policy regarding the active surveillance and prevention of AMR contamination.
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Wen Y, Xie X, Xu P, Yang C, Zhu Z, Zhu J, Lv J, Zhang H, Chen L, Du H. NDM-1 and OXA-48-Like Carbapenemases (OXA-48, OXA-181 and OXA-252) Co-Producing Shewanella xiamenensis from Hospital Wastewater, China. Infect Drug Resist 2022; 15:6927-6938. [PMID: 36471715 PMCID: PMC9719275 DOI: 10.2147/idr.s386345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/09/2022] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Shewanella genus, as an important carrier of resistance genes, has the potential to transmit resistance to many antimicrobials in many circumstances, especially in aquatic environment. The aim of the study was to describe the risk of Shewanella xiamenensis in hospital environment through analysis of genomic comparison and resistance status. METHODS Seven S. xiamenensis strains were isolated from hospital wastewater. PCR and Sanger sequencing were carried out for detection of common carbapenemase genes. Antimicrobial susceptibility testing was performed to determine the antimicrobial profile. Whole genome sequencing was applied, and sequences were further used for genomic analysis. RESULTS Seven Shewanella xiamenensis were all positive for bla NDM and bla OXA-48. Antimicrobial susceptibility testing showed all Shewanella xiamenensis were resistant to cefotaxime, ceftazidime, imipenem, meropenem, gentamycin and trimethoprim-sulfamethoxazole. Whole genome sequencing and phylogenetic analysis demonstrated the diversity of Shewanella xiamenensis despite isolating from one wastewater pool. CONCLUSION To the best of our knowledge, this is the first report of detection of three types bla OXA-48-like genes in one hospital in China. And we have detected multi-drug resistant S. xiamenensis from hospital wastewater. This emphasizes that the presence of naturally existing carbapenemases in the environment may be significantly overlooked and that the bla OXA-48-like genes in China may originate through the horizontal gene transfer from S. xiamenensis to Enterobacterales rather than import from other countries.
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Affiliation(s)
- Yicheng Wen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Xiaofang Xie
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ping Xu
- Department of Clinical Laboratory, The Fifth People’s Hospital of Suzhou, Suzhou, Jiangsu, People’s Republic of China
| | - Chengcheng Yang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zhichen Zhu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jie Zhu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jingnan Lv
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Haifang Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Liang Chen
- Hackensack Meridian Health Center for Discovery and Innovation, Nutley, NJ, USA
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Hong Du
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
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19
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Robins K, Leonard AFC, Farkas K, Graham DW, Jones DL, Kasprzyk-Hordern B, Bunce JT, Grimsley JMS, Wade MJ, Zealand AM, McIntyre-Nolan S. Research needs for optimising wastewater-based epidemiology monitoring for public health protection. JOURNAL OF WATER AND HEALTH 2022; 20:1284-1313. [PMID: 36170187 DOI: 10.2166/wh.2022.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Wastewater-based epidemiology (WBE) is an unobtrusive method used to observe patterns in illicit drug use, poliovirus, and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The pandemic and need for surveillance measures have led to the rapid acceleration of WBE research and development globally. With the infrastructure available to monitor SARS-CoV-2 from wastewater in 58 countries globally, there is potential to expand targets and applications for public health protection, such as other viral pathogens, antimicrobial resistance (AMR), pharmaceutical consumption, or exposure to chemical pollutants. Some applications have been explored in academic research but are not used to inform public health decision-making. We reflect on the current knowledge of WBE for these applications and identify barriers and opportunities for expanding beyond SARS-CoV-2. This paper critically reviews the applications of WBE for public health and identifies the important research gaps for WBE to be a useful tool in public health. It considers possible uses for pathogenic viruses, AMR, and chemicals. It summarises the current evidence on the following: (1) the presence of markers in stool and urine; (2) environmental factors influencing persistence of markers in wastewater; (3) methods for sample collection and storage; (4) prospective methods for detection and quantification; (5) reducing uncertainties; and (6) further considerations for public health use.
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Affiliation(s)
- Katie Robins
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail: ; School of Engineering, Newcastle University, Cassie Building, Newcastle-upon-Tyne NE1 7RU, UK
| | - Anne F C Leonard
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail: ; University of Exeter Medical School, European Centre for Environment and Human Health, University of Exeter, Cornwall TR10 9FE, UK
| | - Kata Farkas
- School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - David W Graham
- School of Engineering, Newcastle University, Cassie Building, Newcastle-upon-Tyne NE1 7RU, UK
| | - David L Jones
- School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; SoilsWest, Centre for Sustainable Farming Systems, Food Futures Institute, Murdoch University, Murdoch, WA 6105, Australia
| | | | - Joshua T Bunce
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail: ; School of Engineering, Newcastle University, Cassie Building, Newcastle-upon-Tyne NE1 7RU, UK
| | - Jasmine M S Grimsley
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail:
| | - Matthew J Wade
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail: ; School of Engineering, Newcastle University, Cassie Building, Newcastle-upon-Tyne NE1 7RU, UK
| | - Andrew M Zealand
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail:
| | - Shannon McIntyre-Nolan
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail: ; Her Majesty's Prison and Probation Service, Ministry of Justice, London, SW1H 9AJ, UK
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20
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Tiwari A, Paakkanen J, Österblad M, Kirveskari J, Hendriksen RS, Heikinheimo A. Wastewater Surveillance Detected Carbapenemase Enzymes in Clinically Relevant Gram-Negative Bacteria in Helsinki, Finland; 2011–2012. Front Microbiol 2022; 13:887888. [PMID: 35722284 PMCID: PMC9201422 DOI: 10.3389/fmicb.2022.887888] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial resistance profiling of pathogens helps to identify the emergence of rare or new resistance threats and prioritize possible actions to be taken against them. The analysis of wastewater (WW) can reveal the circulation of antimicrobial-resistant bacteria (ARB) and antimicrobial resistance genes (ARG) among the catchment communities. Here, we analyzed WW influent samples to determine the prevalence of carbapenemase genes-carrying Gram-negative bacteria (Carba-GNB) in Helsinki, Finland. This study set important historical reference points from the very early stage of the carbapenemase era, during the period 2011–2012. A total of 405 bacterial isolates grown on CHROMagarKPC (n = 195) and CHROMagarESBL (n = 210) from WW influent samples were collected between October 2011 and August 2012 and were analyzed. The bacterial DNA from the isolates was extracted, and the prevalence of carbapenemases genes blaKPC, blaNDM, blaGES, blaOXA-48, blaIMP, blaIMI, and blaVIM were screened with multiplexed PCR. All carbapenemase-positive isolates were identified taxonomically to species or genus level with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The nucleic acid extraction was successful for 399 isolates, of which 59 (14.8%) were found to carry carbapenemase genes. A total of 89.8% of the carbapenemase positive isolates (53 out of 59) were obtained from CHROMagarKPC plates and only 10.2% (six out of 59) were obtained from CHROMagar ESBL plates. Among the Carba-GNB isolates, 86.4% were blaGES (51 out of 59), 10.2% were blaKPC (six out of 59), and 3.4% were blaVIM (two out of 59). The most common carba-gene, blaGES, was carried by 10 different bacterial species, including Aeromonas spp., Enterobacter spp., and Kluyvera spp.; the blaKPC gene was carried by Escherichia coli, Klebsiella pneumoniae, and Kluyvera cryocescens; and the blaVIM gene was carried by Aeromonas hydrophila/caviae and Citrobacter amalonaticus. This study emphasizes that wastewater surveillance (WWS) can be an additional tool for monitoring antimicrobial resistance (AMR) at the population level.
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Affiliation(s)
- Ananda Tiwari
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Expert Microbiology Unit, Finnish Institute for Health and Welfare, Kuopio, Finland
- Ananda Tiwari,
| | | | - Monica Österblad
- Antimicrobial Resistance Unit, Finnish Institute for Health and Welfare, Turku, Finland
| | | | - Rene S. Hendriksen
- Technical University of Denmark, National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics, Kongens Lyngby, Denmark
| | - Annamari Heikinheimo
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Finnish Food Authority, Seinajöki, Finland
- *Correspondence: Annamari Heikinheimo,
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Yasmin S, Karim AM, Lee SH, Zahra R. Temporal Variation of Meropenem Resistance in E. coli Isolated from Sewage Water in Islamabad, Pakistan. Antibiotics (Basel) 2022; 11:antibiotics11050635. [PMID: 35625279 PMCID: PMC9137590 DOI: 10.3390/antibiotics11050635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/24/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023] Open
Abstract
The WHO has classified carbapenem-resistant Enterobacteriaceae in most critical priority pathogens that pose a threat to human health. The present study investigated the prevalence of meropenem-resistant Escherichia coli (E. coli) in relation to its temporal variation in different seasons along with its resistance markers in sewage water. E. coli was selected on MacConkey agar containing meropenem (3 µg/mL). There were 27% of sites/sewage samples carrying meropenem-resistant E. coli. All E. coli were confirmed through the amplification of the uidA gene. All isolated E. coli were multidrug-resistant (MDR), and among them, 51% were extensively drug-resistant (XDR). An antibiogram determined against 15 antibiotics showed the highest resistance to ampicillin and cefotaxime (98% each) and lowest resistance to fosfomycin (2%). Phylogenetic groups and resistance gene analysis through PCR showed a significant co-occurrence of carbapenemases with extended spectrum beta lactamases (ESBLs), plasmid encoded quinolone, and colistin resistance genes. The higher number of resistance genes in E. coli isolates in community sewage indirectly indicate that these isolates circulate abundantly in the community.
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Affiliation(s)
- Saba Yasmin
- Department of Microbiology, Quaid-i-Azam University, Islamabad 45320, Pakistan;
| | - Asad-Mustafa Karim
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University, Yongin 17058, Korea;
| | - Sang-Hee Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University, Yongin 17058, Korea;
- Correspondence: (S.-H.L.); (R.Z.)
| | - Rabaab Zahra
- Department of Microbiology, Quaid-i-Azam University, Islamabad 45320, Pakistan;
- Correspondence: (S.-H.L.); (R.Z.)
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22
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Carlsen L, Büttner H, Christner M, Franke G, Indenbirken D, Knobling B, Lütgehetmann M, Knobloch J. High burden and diversity of carbapenemase-producing Enterobacterales observed in wastewater of a tertiary care hospital in Germany. Int J Hyg Environ Health 2022; 242:113968. [PMID: 35390565 DOI: 10.1016/j.ijheh.2022.113968] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/10/2022] [Accepted: 03/28/2022] [Indexed: 12/01/2022]
Abstract
Hospitals are one of the main reservoirs of multi-resistant Enterobacterales (MRE). As MRE are resistant to the most frequently used antibiotics, therapy for patients with MRE infections is challenging. It has been previously described that MRE from hospital wastewater can pass into municipal wastewater and even surface water. In this study, we investigated the diversity and epidemiology of MRE in the wastewater of a large tertiary care hospital. Wastewater samples were collected for a four-day period and tested for the presence of Enterobacterales resistant to 3rd gen. cephalosporins. Representative isolates were further characterized by whole genome sequencing. In 120 β-glucuronidase-producing isolates, 68 Escherichia coli and, interestingly, also 52 Citrobacter freundii were identified. In 120 β-glucosidase-producing isolates 45 Serratia marcescens, 34 Klebsiella oxytoca, 32 Enterobacter cloacae and 9 Klebsiella pneumoniae were observed. For all species various MLST sequence types and different clusters of resistance genes were determined, showing a great diversity within the different Enterobacterales, further corroborated by clonal analysis performed by cgMLST. The most prominent clone was wastewater associated E. coli ST635, which accounted for 47.1% of all E. coli isolates. Interestingly, 45.6% of E. coli, 88.5% of C. freundii, 95.6% of S. marcescens, 91.2% of K. oxytoca, 96.9% of E. cloacae and 88.9% of K. pneumoniae isolates carried a carbapenemase gene, indicating a high burden with carbapenemase-producing Enterobacterales. Comparison with clinical isolates from the same hospital displayed few clonal matches. One wastewater isolate of K. pneumoniae was identified to be closely related compared to a clone that had been introduced into the hospital during an outbreak four years earlier. One E. coli isolate was identified as identical to an isolate from a patient, with inpatient stay during the sampling period. The data obtained in this study highlight the problem of antibiotic resistance of Enterobacterales in hospital wastewater. In particular, the clustered occurrence of carbapenemase genes is of great concern and underscores the problem of increasingly scarce antibiotic options against these bacteria.
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Affiliation(s)
- Laura Carlsen
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Henning Büttner
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Christner
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gefion Franke
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniela Indenbirken
- Virus Genomics, Heinrich-Pette-Institute, Leibniz Institute for Experimental Biology, Martinistraße 52, 20251, Hamburg, Germany
| | - Birte Knobling
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Knobloch
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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23
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Chau KK, Barker L, Budgell EP, Vihta KD, Sims N, Kasprzyk-Hordern B, Harriss E, Crook DW, Read DS, Walker AS, Stoesser N. Systematic review of wastewater surveillance of antimicrobial resistance in human populations. ENVIRONMENT INTERNATIONAL 2022; 162:107171. [PMID: 35290866 PMCID: PMC8960996 DOI: 10.1016/j.envint.2022.107171] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/23/2022] [Accepted: 02/28/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVES We systematically reviewed studies using wastewater for AMR surveillance in human populations, to determine: (i) evidence of concordance between wastewater-human AMR prevalence estimates, and (ii) methodological approaches which optimised identifying such an association, and which could be recommended as standard. We used Lin's concordance correlation coefficient (CCC) to quantify concordance between AMR prevalence estimates in wastewater and human compartments (where CCC = 1 reflects perfect concordance), and logistic regression to identify study features (e.g. sampling methods) associated with high agreement studies (defined as >70% of within-study wastewater-human AMR prevalence comparisons within ±10%). RESULTS Of 8,867 records and 441 full-text methods reviewed, 33 studies were included. AMR prevalence data was extractable from 24 studies conducting phenotypic-only (n = 7), genotypic-only (n = 1) or combined (n = 16) AMR detection. Overall concordance of wastewater-human AMR prevalence estimates was reasonably high for both phenotypic (CCC = 0.85 [95% CI 0.8-0.89]) and genotypic approaches (CCC = 0.88 (95% CI 0.84-0.9)) despite diverse study designs, bacterial species investigated and phenotypic/genotypic targets. No significant relationships between methodological approaches and high agreement studies were identified using logistic regression; however, this was limited by inconsistent reporting of study features, significant heterogeneity in approaches and limited sample size. Based on a secondary, descriptive synthesis, studies conducting composite sampling of wastewater influent, longitudinal sampling >12 months, and time-/location-matched sampling of wastewater and human compartments generally had higher agreement. CONCLUSION Wastewater-based surveillance of AMR appears promising, with high overall concordance between wastewater and human AMR prevalence estimates in studies irrespective of heterogenous approaches. However, our review suggests future work would benefit from: time-/location-matched sampling of wastewater and human populations, composite sampling of influent, and sampling >12 months for longitudinal studies. Further research and clear and consistent reporting of study methods is required to identify optimal practice.
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Affiliation(s)
- K K Chau
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - L Barker
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - E P Budgell
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - K D Vihta
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - N Sims
- Department of Chemistry, Faculty of Science, University of Bath, Bath BA2 7AY, United Kingdom.
| | - B Kasprzyk-Hordern
- Department of Chemistry, Faculty of Science, University of Bath, Bath BA2 7AY, United Kingdom.
| | - E Harriss
- Bodleian Healthcare Libraries, University of Oxford, Oxford OX3 9DU, United Kingdom.
| | - D W Crook
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - D S Read
- UK Centre for Ecology & Hydrology, Wallingford OX10 8BB, United Kingdom.
| | - A S Walker
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford OX4 2PG, United Kingdom.
| | - N Stoesser
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
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24
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Hazra M, Durso LM. Performance Efficiency of Conventional Treatment Plants and Constructed Wetlands towards Reduction of Antibiotic Resistance. Antibiotics (Basel) 2022; 11:114. [PMID: 35052991 PMCID: PMC8773441 DOI: 10.3390/antibiotics11010114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 12/18/2022] Open
Abstract
Domestic and industrial wastewater discharges harbor rich bacterial communities, including both pathogenic and commensal organisms that are antibiotic-resistant (AR). AR pathogens pose a potential threat to human and animal health. In wastewater treatment plants (WWTP), bacteria encounter environments suitable for horizontal gene transfer, providing an opportunity for bacterial cells to acquire new antibiotic-resistant genes. With many entry points to environmental components, especially water and soil, WWTPs are considered a critical control point for antibiotic resistance. The primary and secondary units of conventional WWTPs are not designed for the reduction of resistant microbes. Constructed wetlands (CWs) are viable wastewater treatment options with the potential for mitigating AR bacteria, their genes, pathogens, and general pollutants. Encouraging performance for the removal of AR (2-4 logs) has highlighted the applicability of CW on fields. Their low cost of construction, operation and maintenance makes them well suited for applications across the globe, especially in developing and low-income countries. The present review highlights a better understanding of the performance efficiency of conventional treatment plants and CWs for the elimination/reduction of AR from wastewater. They are viable alternatives that can be used for secondary/tertiary treatment or effluent polishing in combination with WWTP or in a decentralized manner.
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Affiliation(s)
- Moushumi Hazra
- Department of Hydrology, Indian Institute of Technology, Roorkee 247667, Uttarakhand, India
| | - Lisa M. Durso
- Agroecosystem Management Research Unit, Agricultural Research Service, United States Department of Agriculture, Lincoln, NE 68583, USA;
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25
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Fakonti G, Hadjikou A, Tzira E, Kyprianidou M, Giannakou K. Attitudes and perceptions of mothers towards childhood vaccination in Greece: lessons to improve the childhood COVID-19 vaccination acceptance. Front Pediatr 2022; 10:951039. [PMID: 36090549 PMCID: PMC9453258 DOI: 10.3389/fped.2022.951039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/21/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Maternal attitudes and beliefs have been shown to influence childhood vaccination coverage, resulting in under-vaccination, non-vaccination, and vaccination delay. This study aimed to investigate the mothers' attitudes and perceptions about vaccination for their children in Greece. METHODS This was an online cross-sectional study, conducted from 4 April to 8 June 2020. A self-administered questionnaire was used to collect information about mothers' and their children's socio-demographic characteristics, previous vaccination behavior, and mothers' attitudes and perceptions about childhood vaccination. Participants included adult mothers with at least one minor child. RESULTS One thousand eight hundred eighty-five mothers participated, with the majority (91.7%) believing in the usefulness of vaccines and that vaccines protect children from serious and life-threatening diseases. A larger percentage of mothers with higher educational attainment agreed/absolutely agreed that all vaccinations provided by the National Vaccination Program must be offered to their children (91.6%) (p = 0.02) and that vaccines protect children from serious and life-threatening diseases (92.9%) (p = 0.01). Significant more married/in cohabitation and not single-parent mothers agreed that vaccines are safe (53.5% and 53.4%, respectively). There were also several significant associations between maternal attitudes toward childhood vaccination and previous maternal vaccination practices [(e.g., adherence to recommended vaccination dosages (all p-values < 0.01), vaccination delays (all p-values < 0.05), and vaccination during pregnancy (all p-values < 0.01)]. CONCLUSION Maternal attitudes and perceptions toward childhood vaccination are significantly influenced by sociodemographic factors and maternal vaccination practices. Revealing those is essential for public health officials in developing future strategies to improve childhood vaccination coverage and acceptance of new vaccines such as the COVID-19 vaccine.
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Affiliation(s)
- Georgia Fakonti
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Andria Hadjikou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Eleana Tzira
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Maria Kyprianidou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
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Abstract
Antibiotic resistance is a global health challenge, involving the transfer of bacteria and genes between humans, animals and the environment. Although multiple barriers restrict the flow of both bacteria and genes, pathogens recurrently acquire new resistance factors from other species, thereby reducing our ability to prevent and treat bacterial infections. Evolutionary events that lead to the emergence of new resistance factors in pathogens are rare and challenging to predict, but may be associated with vast ramifications. Transmission events of already widespread resistant strains are, on the other hand, common, quantifiable and more predictable, but the consequences of each event are limited. Quantifying the pathways and identifying the drivers of and bottlenecks for environmental evolution and transmission of antibiotic resistance are key components to understand and manage the resistance crisis as a whole. In this Review, we present our current understanding of the roles of the environment, including antibiotic pollution, in resistance evolution, in transmission and as a mere reflection of the regional antibiotic resistance situation in the clinic. We provide a perspective on current evidence, describe risk scenarios, discuss methods for surveillance and the assessment of potential drivers, and finally identify some actions to mitigate risks.
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Affiliation(s)
- D. G. Joakim Larsson
- grid.8761.80000 0000 9919 9582Centre for Antibiotic Resistance Research at University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl-Fredrik Flach
- grid.8761.80000 0000 9919 9582Centre for Antibiotic Resistance Research at University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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27
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Grevskott DH, Ghavidel FZ, Svanevik CS, Marathe NP. Resistance profiles and diversity of β-lactamases in Escherichia coli strains isolated from city-scale sewage surveillance in Bergen, Norway mimic clinical prevalence. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 226:112788. [PMID: 34571418 DOI: 10.1016/j.ecoenv.2021.112788] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
The aim of this study was to examine antibiotic resistance profiles and diversity of β-lactamases in Escherichia coli present within the population and the potential spread of resistant E. coli into the receiving environment using city-scale sewage surveillance. In E. coli isolates from ECC plates without antibiotics from ten influent samples (n = 300), highest resistance was observed against ampicillin (16.6%), sulfamethoxazole (9.7%) and trimethoprim (9.0%), while in effluent samples (n = 262) it was against sulfamethoxazole (11.8%), ampicillin (11.5%) and tetracycline (8.8%). All isolates (n = 123) obtained on cefotaxime-containing plates were multidrug-resistant. Several clinically important antibiotic resistance genes (ARGs) were detected in 46 E. coli isolates subjected to whole-genome sequencing, including carbapenemases like NDM-6, VIM-1 and OXA-48-variant, as well as tigecycline resistance gene tet(X4). CTX-M-15 was the most prevalent (42.9%) extended-spectrum β-lactamase among cefotaxime-resistant isolates, followed by CTX-M-27 (31.4%) and CTX-M-14 (17.1%), resembling clinical prevalence in Norway. Most of the sequenced isolates carried other clinically relevant ARGs, such as dfrA17, sul1, sul2, tet(A), aph(6)-Id, aph(3'')-Ib and aadA5. Sixteen different sequence types (STs) were identified, including ST131 (39.1%), ST38 (10.9%) and ST69 (8.7%). One E. coli isolate belonging to novel ST (ST11874) carried multiple virulence factors including genotoxin, salmochelin, aerobactin and yersiniabactin, suggesting that this isolate has potential to cause health concerns in future. Our study reveals presence of clinically relevant ARGs like blaNDM-6 and tet(X4) in pathogenic strains, which have so far not been reported from the clinics in Norway. Our study may thus, provide a framework for population-based surveillance of antibiotic resistance.
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Affiliation(s)
- Didrik H Grevskott
- Department of Contaminants and Biohazards, Institute of Marine Research (IMR), Bergen, Norway
| | - Fatemeh Z Ghavidel
- Department of Contaminants and Biohazards, Institute of Marine Research (IMR), Bergen, Norway
| | - Cecilie S Svanevik
- Department of Contaminants and Biohazards, Institute of Marine Research (IMR), Bergen, Norway
| | - Nachiket P Marathe
- Department of Contaminants and Biohazards, Institute of Marine Research (IMR), Bergen, Norway.
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Anjum MF, Schmitt H, Börjesson S, Berendonk TU. The potential of using E. coli as an indicator for the surveillance of antimicrobial resistance (AMR) in the environment. Curr Opin Microbiol 2021; 64:152-158. [PMID: 34739920 DOI: 10.1016/j.mib.2021.09.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
To understand the dynamics of antimicrobial resistance (AMR), in a One-Health perspective, surveillance play an important role. Monitoring systems already exist in the human health and livestock sectors, but there are no environmental monitoring programs. Therefore there is an urgent need to initiate environmental AMR monitoring programs nationally and globally, which will complement existing systems in different sectors. However, environmental programs should not only identify anthropogenic influences and levels of AMR, but they should also allow for identification of transmissions to and from human and animal populations. In the current review we therefore propose using antimicrobial resistant Escherichia coli as indicators for monitoring occurrence and levels of AMR in the environment, including wildlife.
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Affiliation(s)
- Muna F Anjum
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, New Haw, Addlestone, Surrey, KT15 3NB, UK
| | - Heike Schmitt
- Centre for Zoonoses and Environmental Microbiology - Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3720 BA, Bilthoven, The Netherlands
| | - Stefan Börjesson
- Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute (SVA), 751 89, Uppsala, Sweden.
| | - Thomas U Berendonk
- Institute for Hydrobiology, Technische Universität Dresden, 01217, Dresden, Germany.
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Guruge KS, Tamamura YA, Goswami P, Tanoue R, Jinadasa KBSN, Nomiyama K, Ohura T, Kunisue T, Tanabe S, Akiba M. The association between antimicrobials and the antimicrobial-resistant phenotypes and resistance genes of Escherichia coli isolated from hospital wastewaters and adjacent surface waters in Sri Lanka. CHEMOSPHERE 2021; 279:130591. [PMID: 33894511 DOI: 10.1016/j.chemosphere.2021.130591] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/26/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
The presence of antimicrobials, antimicrobial-resistant bacteria (ARB), and the associated antimicrobial resistance genes (ARGs) in the environment is a global health concern. In this study, the concentrations of 25 antimicrobials, the resistance of Escherichia coli (E. coli) strains in response to the selection pressure imposed by 15 antimicrobials, and enrichment of 20 ARGs in E. coli isolated from hospital wastewaters and surface waters were investigated from 2016 to 2018. In hospital wastewaters, clarithromycin was detected at the highest concentration followed by sulfamethoxazole and sulfapyridine. Approximately 80% of the E. coli isolates were resistant, while 14% of the isolates exhibited intermediate resistance against the tested antimicrobial agents. Approximately 61% of the examined isolates were categorized as multidrug-resistant bacteria. The overall abundance of phenotypes that were resistant toward drugs was in the following order: β-lactams, tetracycline, quinolones, sulfamethoxazole/trimethoprim, aminoglycosides, and chloramphenicol. The data showed that the E. coli isolates frequently harbored blaTEM, blaCTX-M, tetA, qnrS, and sul2. These results indicated that personal care products were significantly associated with the presence of several resistant phenotypes and resistance genes, implying their role in co-association with multidrug resistance. Statistical analysis also indicated a disparity specific to the site, treatment, and year in the data describing the prevalence of ARB and ARGs and their release into downstream waters. This study provides novel insights into the abundance of antimicrobial, ARB and ARGs in Sri Lanka, and could further offer invaluable information that can be integrated into global antimicrobial resistance databases.
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Affiliation(s)
- Keerthi S Guruge
- National Institute of Animal Health, National Agriculture and Food Research Organization, 3-1-5 Kannondai, Tsukuba, 305-0856, Ibaraki, Japan; Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-oraikita, Izumisano, Osaka, 598-8531, Japan; National Institute of Fundamental Studies, Hantana Road, Kandy, Sri Lanka.
| | - Yukino A Tamamura
- National Institute of Animal Health, National Agriculture and Food Research Organization, 3-1-5 Kannondai, Tsukuba, 305-0856, Ibaraki, Japan
| | - Prasun Goswami
- Atal Centre for Ocean Science and Technology for Islands, ESSO - National Institute of Ocean Technology, Dollygunj, Port Blair, 744103, Andaman and Nicobar Islands, India
| | - Rumi Tanoue
- Center for Marine Environmental Studies, Ehime University, 2-5 Bunkyo-cho, Matsuyama, Ehime, 790-8577, Japan
| | - K B S N Jinadasa
- Department of Civil Engineering, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Kei Nomiyama
- Center for Marine Environmental Studies, Ehime University, 2-5 Bunkyo-cho, Matsuyama, Ehime, 790-8577, Japan
| | - Takeshi Ohura
- Graduate School of Agriculture, Meijo University, 1-501 Shiogamaguchi, Nagoya, 468-8502, Japan
| | - Tatsuya Kunisue
- Center for Marine Environmental Studies, Ehime University, 2-5 Bunkyo-cho, Matsuyama, Ehime, 790-8577, Japan
| | - Shinsuke Tanabe
- Center for Marine Environmental Studies, Ehime University, 2-5 Bunkyo-cho, Matsuyama, Ehime, 790-8577, Japan
| | - Masato Akiba
- National Institute of Animal Health, National Agriculture and Food Research Organization, 3-1-5 Kannondai, Tsukuba, 305-0856, Ibaraki, Japan
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Zhang S, Chen S, Rehman MU, Yang H, Yang Z, Wang M, Jia R, Chen S, Liu M, Zhu D, Zhao X, Wu Y, Yang Q, Huan J, Ou X, Mao S, Gao Q, Sun D, Tian B, Cheng A. Distribution and association of antimicrobial resistance and virulence traits in Escherichia coli isolates from healthy waterfowls in Hainan, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 220:112317. [PMID: 34049228 DOI: 10.1016/j.ecoenv.2021.112317] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
There are rising concerns about microbes harboring antibiotic resistance genes (ARGs) and virulence-associated genes (VAGs) in humans and food-producing animals. Moreover, ARGs are considered as emerging environmental pollutants, posing probable life-threatening complications in humans and animals. Commensal Escherichia coli (E. coli) strain can carry a large number of VAGs, which may become opportunistic pathogen. The objective of this study was to determine the prevalence and possible association of ARGs and VAGs in E. coli isolates from clinically healthy waterfowls in China's tropical island, Hainan. For this purpose, 311 non-repeating E. coli isolates were evaluated for phenotypic drug resistance linked with ARGs. Additionally, strains were examined for subsequent resistance and virulence genes by uniplex or multiplex PCR and sequencing. Overall, 89 types of antibiotic resistance patterns were analysed, while 25 ARGs and 23 VAGs were observed, of which qnrS (99.4%) and iucD (99.7%) were the most commonly found genes, respectively. Significant positive associations were observed among ARGs and VAGs (p<0.05, OR>1). The strongest association between resistance and virulence gene was observed for qnrS and iss (OR, 76.25; 95% CI, 4.02-1445.42). Our results propose that waterfowls serve as a reservoir of E. coli carrying multi ARGs and various ExPEC associated VAGs. Therefore, this study provides necessary information on the occurrence and possible associations of ARGs and VAGs in healthy waterfowls, which may act as a reference for the regulatory use of antibiotics to stop the direct or indirect spread of these resistant and potential virulent microbes to natural environment.
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Affiliation(s)
- Shaqiu Zhang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China.
| | - Shuling Chen
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Mujeeb Ur Rehman
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Hong Yang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Zhishuang Yang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Mingshu Wang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Renyong Jia
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Shun Chen
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Mafeng Liu
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Dekang Zhu
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Xinxin Zhao
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Ying Wu
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Qiao Yang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Juan Huan
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Xumin Ou
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Sai Mao
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Qun Gao
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Di Sun
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Bin Tian
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China
| | - Anchun Cheng
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu 611130, PR China.
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Schmiege D, Zacharias N, Sib E, Falkenberg T, Moebus S, Evers M, Kistemann T. Prevalence of multidrug-resistant and extended-spectrum beta-lactamase-producing Escherichia coli in urban community wastewater. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 785:147269. [PMID: 33932656 DOI: 10.1016/j.scitotenv.2021.147269] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 05/28/2023]
Abstract
Antibiotic resistance (ABR) and the spread of multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli via wastewater to environmental compartments are of rapidly growing global health concern. Health care facilities, industries and slaughterhouses discharge high loads of ABR bacteria with their wastewater. However, the general community is often the biggest indirect discharger. Yet, research focusing explicitly on this important diffuse source is rather scarce raising questions about variations in the occurrence of ESBL-producing E. coli in wastewater from different communities and over time. Between April 2019 and March 2020, wastewater from three socio-spatially different districts in the Ruhr Metropolis, Germany, and the receiving wastewater treatment plant was sampled monthly and analysed for the occurrence of ESBL-producing E. coli via culture-based methods. Isolates were validated with matrix assisted laser desorption ionization time of flight mass spectrometry and antibiotic resistance profiles were analysed via microdilution. Results were interpreted using the European Committee on Antimicrobial Susceptibility Testing criteria. The German Commission for Hospital Hygiene and Infection Prevention criteria were used for multidrug-resistance categorization. Phenotypic ESBL-producing E. coli could be isolated from every wastewater sample demonstrating that the general community is an important indirect discharger. The socio-spatially disadvantaged area displayed higher absolute loads of ESBL-producing E. coli compared to the other two areas, as well as higher adjusted loads for domestic discharge and inhabitants, particularly during winter, indicating a higher ABR burden. Thirty-two isolates (28.6%) were characterized as multidrug-resistant Gram-negative bacteria (3MRGN). Resistance profiles varied only for those antibiotics, which can be administered in outpatient care. Resistance levels tended to be around 10% lower in the socio-spatially advantaged area. This study shows that spatial and seasonal influences regarding the occurrence of ESBL-producing E. coli in wastewater from socio-spatially different communities are identifiable.
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Affiliation(s)
- Dennis Schmiege
- Department of Geography, University of Bonn, Meckenheimer Allee 166, 53115 Bonn, Germany; Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Center for Development Research, University of Bonn, Genscherallee 3, 53113 Bonn, Germany; Institute for Urban Public Health, Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
| | - Nicole Zacharias
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Esther Sib
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Timo Falkenberg
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Center for Development Research, University of Bonn, Genscherallee 3, 53113 Bonn, Germany.
| | - Susanne Moebus
- Institute for Urban Public Health, Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
| | - Mariele Evers
- Department of Geography, University of Bonn, Meckenheimer Allee 166, 53115 Bonn, Germany.
| | - Thomas Kistemann
- Department of Geography, University of Bonn, Meckenheimer Allee 166, 53115 Bonn, Germany; Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Center for Development Research, University of Bonn, Genscherallee 3, 53113 Bonn, Germany.
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Kalanxhi E, Osena G, Kapoor G, Klein E. Confidence interval methods for antimicrobial resistance surveillance data. Antimicrob Resist Infect Control 2021; 10:91. [PMID: 34108041 PMCID: PMC8191092 DOI: 10.1186/s13756-021-00960-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is one of the greatest global health challenges today, but burden assessment is hindered by uncertainty of AMR prevalence estimates. Geographical representation of AMR estimates typically pools data collected from several laboratories; however, these aggregations may introduce bias by not accounting for the heterogeneity of the population that each laboratory represents. Methods We used AMR data from up to 381 laboratories in the United States from The Surveillance Network to evaluate methods for estimating uncertainty of AMR prevalence estimates. We constructed confidence intervals for the proportion of resistant isolates using (1) methods that account for the clustered structure of the data, and (2) standard methods that assume data independence. Using samples of the full dataset with increasing facility coverage levels, we examined how likely the estimated confidence intervals were to include the population mean. Results Methods constructing 95% confidence intervals while accounting for possible within-cluster correlations (Survey and standard methods adjusted to employ cluster-robust errors), were more likely to include the sample mean than standard methods (Logit, Wilson score and Jeffreys interval) operating under the assumption of independence. While increased geographical coverage improved the probability of encompassing the mean for all methods, large samples still did not compensate for the bias introduced from the violation of the data independence assumption. Conclusion General methods for estimating the confidence intervals of AMR rates that assume data are independent, are likely to produce biased results. When feasible, the clustered structure of the data and any possible intra-cluster variation should be accounted for when calculating confidence intervals around AMR estimates, in order to better capture the uncertainty of prevalence estimates. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00960-5.
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Affiliation(s)
- Erta Kalanxhi
- Center for Disease Dynamics, Economics and Policy (CDDEP), Washington, DC, USA
| | - Gilbert Osena
- Center for Disease Dynamics, Economics and Policy (CDDEP), Washington, DC, USA
| | - Geetanjali Kapoor
- Center for Disease Dynamics, Economics and Policy (CDDEP), Washington, DC, USA
| | - Eili Klein
- Center for Disease Dynamics, Economics and Policy (CDDEP), Washington, DC, USA. .,Johns Hopkins University, Baltimore, MD, USA.
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Tsai MA, Chang CC, Li TH. Antimicrobial-resistance profiles of gram-negative bacteria isolated from green turtles (Chelonia mydas) in Taiwan. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 277:116870. [PMID: 33714128 DOI: 10.1016/j.envpol.2021.116870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 06/12/2023]
Abstract
The green turtle (Chelonia mydas) is listed as a globally endangered species and is vulnerable to anthropogenic threats, including environmental pollution. This study investigated the antimicrobial resistance of Gram-negative bacteria isolated from wild green turtles admitted to a sea turtle rehabilitation center in Taiwan. For this investigation, cloacal and nasal swab samples were collected from 28 green turtles between 2018 and 2020, from which a total of 47 Gram-negative bacterial isolates were identified. Among these, Vibrio spp. were the most dominant isolate (31.91%), and 89.36% of the 47 isolates showed resistance to at least one of 18 antimicrobial agents tested. Isolates resistant to one (6.38%), two (8.51%), and multiple (74.47%) antimicrobials were observed. The antimicrobial agents to which isolates showed the greatest resistance were penicillin (74.47%), followed by spiramycin, amoxicillin, and cephalexin. The antimicrobial-resistance profiles identified in this study provide useful information for the clinical treatment of sea turtles in rehabilitation facilities. The results of our study also imply that wild green turtles may be exposed to polluting effluents containing antimicrobials when the turtles traverse migratory corridors or forage in feeding habitats. To benefit sea turtle conservation, future research should focus on (1) how to prevent pollution from antimicrobials in major green turtle activity areas and (2) identifying sources of antimicrobial-resistant bacterial strains in coastal waters of Taiwan.
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Affiliation(s)
- Ming-An Tsai
- Department of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, 91201, Taiwan; International Degree Program of Ornamental Fish Science and Technology, International College, National Pingtung University of Science and Technology, Pingtung, 91201, Taiwan.
| | - Chao-Chin Chang
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung Hsing University, Taichung, 40227, Taiwan.
| | - Tsung-Hsien Li
- National Museum of Marine Biology and Aquarium, Checheng, Pingtung, 94450, Taiwan.
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Chapman J, Orrell-Trigg R, Kwoon KY, Truong VK, Cozzolino D. A high-throughput and machine learning resistance monitoring system to determine the point of resistance for Escherichia coli with tetracycline: Combining UV-visible spectrophotometry with principal component analysis. Biotechnol Bioeng 2021; 118:1511-1519. [PMID: 33399220 DOI: 10.1002/bit.27664] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/13/2020] [Accepted: 12/29/2020] [Indexed: 12/11/2022]
Abstract
UV-visible spectroscopy (UV-Vis) is routinely used in microbiology as a tool to check the optical density (OD) pertaining to the growth stages of microbial cultures at the single wavelength of 600 nm, better known as the OD600 . Typically, modern UV-Vis spectrophotometers can scan in the region of approximately 200-1000 nm in the electromagnetic spectrum, where users do not extend the use of the instrument's full capability in a laboratory. In this study, the full potential of UV-Vis spectrophotometry (multiwavelength collection) was used to examine bacterial growth phases when treated with antibiotics showcasing the ability to understand the point of resistance when an antibiotic is introduced into the media and therefore understand the biochemical changes of the infectious pathogens. A multiplate reader demonstrated a high throughput experiment (96 samples) to understand the growth of Escherichia coli when varied concentrations of the antibiotic tetracycline was added into the well plates. Principal component analysis (PCA) and partial least squares discriminant analysis were then used as the data mining techniques to interpret the UV-Vis spectral data and generate machine learning "proof of principle" for the UV-Vis spectrophotometer plate reader. Results from this study showed that the PCA analysis provides an accurate yet simple visual classification and the recognition of E. coli samples belonging to each treatment. These data show significant advantages when compared to the traditional OD600 method where we can now understand biochemical changes in the system rather than a mere optical density measurement. Due to the unique experimental setup and procedure that involves indirect use of antibiotics, the same test could be used for obtaining practical information on the type, resistance, and dose of antibiotic necessary to establish the optimum diagnosis, treatment, and decontamination strategies for pathogenic and antibiotic resistant species.
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Affiliation(s)
- James Chapman
- Department of Applied Chemistry and Environmental Science, School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Rebecca Orrell-Trigg
- Department of Applied Chemistry and Environmental Science, School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Ki Y Kwoon
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Vi K Truong
- Department of Applied Chemistry and Environmental Science, School of Science, RMIT University, Melbourne, Victoria, Australia.,Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Daniel Cozzolino
- Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation (QAAFI), The University of Queensland, Brisbane, Queensland, Australia
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Karkman A, Berglund F, Flach CF, Kristiansson E, Larsson DGJ. Predicting clinical resistance prevalence using sewage metagenomic data. Commun Biol 2020; 3:711. [PMID: 33244050 PMCID: PMC7692497 DOI: 10.1038/s42003-020-01439-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022] Open
Abstract
Antibiotic resistance surveillance through regional and up-to-date testing of clinical isolates is a foundation for implementing effective empirical treatment. Surveillance data also provides an overview of geographical and temporal changes that are invaluable for guiding interventions. Still, due to limited infrastructure and resources, clinical surveillance data is lacking in many parts of the world. Given that sewage is largely made up of human fecal bacteria from many people, sewage epidemiology could provide a cost-efficient strategy to partly fill the current gap in clinical surveillance of antibiotic resistance. Here we explored the potential of sewage metagenomic data to assess clinical antibiotic resistance prevalence using environmental and clinical surveillance data from across the world. The sewage resistome correlated to clinical surveillance data of invasive Escherichia coli isolates, but none of several tested approaches provided a sufficient resolution for clear discrimination between resistance towards different classes of antibiotics. However, in combination with socioeconomic data, the overall clinical resistance situation could be predicted with good precision. We conclude that analyses of bacterial genes in sewage could contribute to informing management of antibiotic resistance.
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Affiliation(s)
- Antti Karkman
- Department of Microbiology, University of Helsinki, Helsinki, Finland
- Helsinki Institute of Sustainability Science, University of Helsinki, Helsinki, Finland
| | - Fanny Berglund
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Carl-Fredrik Flach
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Erik Kristiansson
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - D G Joakim Larsson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.
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Li J, Cui M. Kinetic study on the sorption and degradation of antibiotics in the estuarine water: an evaluation based on single and multiple reactions. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:42104-42114. [PMID: 32705565 DOI: 10.1007/s11356-020-10194-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
It is important to study the fate and transport of antibiotics in aquatic environments to reveal their pollution status. The premise behind fate and transport studies is to evaluate the reaction processes of the target antibiotics. However, available research on the environmental behaviors of antibiotics in certain natural waters, such as estuarine water, is scarce. In this study, single reactions such as sorption, biodegradation, and photolysis and multiple degradation reactions of sulfamethoxazole (SMX), trimethoprim (TMP), and ciprofloxacin (CIP) in the estuarine water were studied. The sorption rates of the target antibiotics in the estuarine water-sediment system were very fast, and the sorption amounts varied among sediments and antibiotics. Hydrolysis did not contribute to the degradation of the target antibiotics. Biodegradation had a low contribution to the degradation of the target antibiotics in the estuarine water. In comparison, photolysis was the dominant degradation process for SMX, TMP, and CIP. The rates of photolysis of the tested antibiotics in the estuarine water were greater than those in pure water; thereby, indicating photolysis of these antibiotics was more prone to occur in the estuarine water. In the multiple degradation experiments, it was found that there may be synergistic effects between the single degradation processes. Thus, the aqueous concentrations of antibiotics decreased rapidly by sorption after entering the estuarine water and then decreased relatively slowly by photolysis and biodegradation. This study provides information for evaluating the environmental behaviors of antibiotics in estuarine environments.
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Affiliation(s)
- Jia Li
- School of Environmental Science and Engineering, Yangzhou University, Yangzhou, 225127, China.
- Key Laboratory of Coastal Environmental Process and Ecology Remediation, Yantai Institute of Coastal Zone Research, Chinese Academy of Sciences; Shandong Key Laboratory of Coastal Environmental Processes, YICCAS, Yantai, 264003, China.
| | - Min Cui
- School of Environmental Science and Engineering, Yangzhou University, Yangzhou, 225127, China
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Zhang S, Abbas M, Rehman MU, Huang Y, Zhou R, Gong S, Yang H, Chen S, Wang M, Cheng A. Dissemination of antibiotic resistance genes (ARGs) via integrons in Escherichia coli: A risk to human health. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 266:115260. [PMID: 32717638 DOI: 10.1016/j.envpol.2020.115260] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
With the induction of various emerging environmental contaminants such as antibiotic resistance genes (ARGs), environment is considered as a key indicator for the spread of antimicrobial resistance (AMR). As such, the ARGs mediated environmental pollution raises a significant public health concern worldwide. Among various genetic mechanisms that are involved in the dissemination of ARGs, integrons play a vital role in the dissemination of ARGs. Integrons are mobile genetic elements that can capture and spread ARGs among environmental settings via transmissible plasmids and transposons. Most of the ARGs are found in Gram-negative bacteria and are primarily studied for their potential role in antibiotic resistance in clinical settings. As one of the most common microorganisms, Escherichia coli (E. coli) is widely studied as an indicator carrying drug-resistant genes, so this article aims to provide an in-depth study on the spread of ARGs via integrons associated with E. coli outside clinical settings and highlight their potential role as environmental contaminants. It also focuses on multiple but related aspects that do facilitate environmental pollution, i.e. ARGs from animal sources, water treatment plants situated at or near animal farms, agriculture fields, wild birds and animals. We believe that this updated study with summarized text, will facilitate the readers to understand the primary mechanisms as well as a variety of factors involved in the transmission and spread of ARGs among animals, humans, and the environment.
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Affiliation(s)
- Shaqiu Zhang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, 611130, PR China
| | - Muhammad Abbas
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, 611130, PR China; Livestock and Dairy Development Department Lahore, Punjab, 54000, Pakistan
| | - Mujeeb Ur Rehman
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, 611130, PR China
| | - Yahui Huang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China
| | - Rui Zhou
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China
| | - Siyue Gong
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China
| | - Hong Yang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, 611130, PR China
| | - Shuling Chen
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, 611130, PR China
| | - Mingshu Wang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, 611130, PR China
| | - Anchun Cheng
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, 611130, PR China; Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, 611130, PR China.
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Extracellular DNA (eDNA): Neglected and Potential Sources of Antibiotic Resistant Genes (ARGs) in the Aquatic Environments. Pathogens 2020; 9:pathogens9110874. [PMID: 33114079 PMCID: PMC7690795 DOI: 10.3390/pathogens9110874] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/11/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Over the past decades, the rising antibiotic resistance bacteria (ARB) are continuing to emerge as a global threat due to potential public health risk. Rapidly evolving antibiotic resistance and its persistence in the environment, have underpinned the need for more studies to identify the possible sources and limit the spread. In this context, not commonly studied and a neglected genetic material called extracellular DNA (eDNA) is gaining increased attention as it can be one of the significant drivers for transmission of extracellular ARGS (eARGs) via horizontal gene transfer (HGT) to competent environmental bacteria and diverse sources of antibiotic-resistance genes (ARGs) in the environment. Consequently, this review highlights the studies that address the environmental occurrence of eDNA and encoding eARGs and its impact on the environmental resistome. In this review, we also brief the recent dedicated technological advancements that are accelerating extraction of eDNA and the efficiency of treatment technologies in reducing eDNA that focuses on environmental antibiotic resistance and potential ecological health risk.
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