Antibiotic resistance in European wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence

Pärnänen, Katariina; Narciso-da-Rocha, Carlos; Kneis, David; Berendonk, Thomas U.; Cacace, Damiano; Thuy, Thi; Elpers, Christian; Fatta‐Kassinos, Despo; Henriques, Isabel; Jaeger, Thomas; Karkman, Antti; Martínez, José Luis; Michael, Stella G.; Michael-Kordatou, I.; O’Sullivan, Kristin; Rodríguez-Mozaz, Sara; Schwartz, Thomas; Sheng, Hongjie; Sørum, Henning; Stedtfeld, Robert D.; Tiedje, James M.; Giustina, Saulo Varela Della; Walsh, Fiona; Vaz‐Moreira, Ivone; Virta, Marko; Manaia, Célia M.

doi:10.1126/sciadv.aau9124

Cited by 371 publications

(254 citation statements)

References 28 publications

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“…However, this is in contrast with other findings with bla CTX-M being the most frequent ESBL genes from various samples including in hospital effluent, surface water and WWTPs (34, 39, 86). This result was confirmed by qPCR data performed in another study in the framework of the StARE project which showed the detection of bla TEM genes, where bla SHV and bla CTX-M group 1 were not detected (22). Most of ESBL genes were found in E. coli , others were carried by Klebsiella spp.…”

Section: Discussionsupporting

confidence: 53%

Antibiotic resistant and extended-spectrum β-lactamase producing faecal coliforms in wastewater treatment plant effluent

Smyth

O’Flaherty

Walsh

et al. 2019

Preprint

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26Wastewater treatment plants (WWTPs) provide optimal conditions for the maintenance and 27 spread of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs). In this 28 work we describe the occurrence of antibiotic resistant faecal coliforms and their mechanisms 29 of antibiotic resistance in the effluent of two urban WWTPs in Ireland. Effluent samples were 30 collected from two WWTPs in Spring and Autumn of 2015 and 2016. The bacterial 31 susceptibility patterns to 13 antibiotics were determined. The phenotypic tests were carried out 32 to identify AmpC or extended-spectrum β-lactamase (ESBL) producers. The presence of ESBL 33 genes were detected by PCR. Plasmids carrying ESBL genes were transformed into 34Escherichia coli DH5α recipient and underwent plasmid replicon typing to identify 35 incompatibility groups. More than 90% of isolated faecal coliforms were resistant to 36 amoxicillin and ampicillin, followed by tetracycline (up to 39.82%), ciprofloxacin (up to 37 31.42%) and trimethoprim (up to 37.61%). Faecal coliforms resistant to colistin and imipenem 38 were detected in all effluent samples. Up to 53.98% of isolated faecal coliforms expressed a 39 multi-drug resistance (MRD) phenotype. AmpC production was confirmed in 5.22% of 40 isolates. The ESBL genes were confirmed for 11.84% of isolates (9.2% of isolates carried 41 blaTEM, 1.4% blaSHV-12, 0.2% blaCTX-M-1 and 1% blaCTX-M-15). Plasmids extracted from 52 ESBL 42 isolates were successfully transformed into recipient E. coli. The detected plasmid 43 incompatibility groups included the IncF group, IncI1, IncHI1/2 and IncA/C. These results 44 provide evidence that treated wastewater is polluted with ARB and MDR faecal coliforms and 45 are sources of ESBL-producing, carbapenem and colistin resistant Enterobacteriaceae. 46 47 48 49 Keywords 50 Antibiotic resistance, multidrug resistance, AmpC, extended-spectrum β-lactamase (ESBL), 51 plasmids 52 53 54 55 56 3

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Section: Discussionsupporting

confidence: 53%

Antibiotic resistant and extended-spectrum β-lactamase producing faecal coliforms in wastewater treatment plant effluent

Smyth

O’Flaherty

Walsh

et al. 2019

Preprint

Self Cite

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“…Generally, high levels of ARB, including MDR strains and diverse ARGs, have been detected in influent wastewater (untreated) collected from various sources, particularly low-income settings [41,44]; hospitals [36,39,40,42,46,47] and pharmaceutical waste [49,60]. However, many studies demonstrated that effluent samples collected from urban, hospital and pharmaceutical-treated wastewater still contain elevated levels of diverse ARGs, ARB and antimicrobial drugs [49,58,60,63].…”

Section: Selective Pressure Within Wastewater Environments Promote Thmentioning

confidence: 99%

“…These studies highlight the role of aquatic ecosystems, particularly wastewater, as a key reservoir of AMR bacteria and ARGs in the environment. High levels of both ARBs and/or ARGs were detected in samples collected from different types of wastewater, including municipal sewage [39,46,47,54,81] and influent and effluent samples from wastewater treatment plants (WWTPs) [37,42,44,55,63,64,[70][71][72]78,79]. Similarly, high levels of AMR were identified in industrial [66,77,92] and agricultural wastewater and samples recovered from pharmaceutical treatment plants [49,66].…”

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confidence: 99%

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The Contribution of Wastewater to the Transmission of Antimicrobial Resistance in the Environment: Implications of Mass Gathering Settings

et al. 2020

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Antimicrobial resistance (AMR) is the major issue posing a serious global health threat. Low- and middle-income countries are likely to be the most affected, both in terms of impact on public health and economic burden. Recent studies highlighted the role of resistance networks on the transmission of AMR organisms, with this network being driven by complex interactions between clinical (e.g., human health, animal husbandry and veterinary medicine) and other components, including environmental factors (e.g., persistence of AMR in wastewater). Many studies have highlighted the role of wastewater as a significant environmental reservoir of AMR as it represents an ideal environment for AMR bacteria (ARB) and antimicrobial resistant genes (ARGs) to persist. Although the treatment process can help in removing or reducing the ARB load, it has limited impact on ARGs. ARGs are not degradable; therefore, they can be spread among microbial communities in the environment through horizontal gene transfer, which is the main resistance mechanism in most Gram-negative bacteria. Here we analysed the recent literature to highlight the contribution of wastewater to the emergence, persistence and transmission of AMR under different settings, particularly those associated with mass gathering events (e.g., Hajj and Kumbh Mela).

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“…New considerations in source-attribution modelling, such as including spatiotemporal factors, multidirectional transmission and different properties of pathogen subtypes in interaction with the sources may be facilitated with the use of WGS (Mughini-Gras et al, 2018b;Palma et al, 2018), additionally supporting the investigation of transmission pathways.…”

Section: Identification Of Transmission Pathwaysmentioning

confidence: 99%

Whole genome sequencing and metagenomics for outbreak investigation, source attribution and risk assessment of food‐borne microorganisms

Koutsoumanis¹,

Allende²,

Álvarez‐Ordóñez³

et al. 2019

EFS2

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This Opinion considers the application of whole genome sequencing (WGS) and metagenomics for outbreak investigation, source attribution and risk assessment of food-borne pathogens. WGS offers the highest level of bacterial strain discrimination for food-borne outbreak investigation and sourceattribution as well as potential for more precise hazard identification, thereby facilitating more targeted risk assessment and risk management. WGS improves linking of sporadic cases associated with different food products and geographical regions to a point source outbreak and can facilitate epidemiological investigations, allowing also the use of previously sequenced genomes. Source attribution may be favoured by improved identification of transmission pathways, through the integration of spatial-temporal factors and the detection of multidirectional transmission and pathogenhost interactions. Metagenomics has potential, especially in relation to the detection and characterisation of non-culturable, difficult-to-culture or slow-growing microorganisms, for tracking of hazard-related genetic determinants and the dynamic evaluation of the composition and functionality of complex microbial communities. A SWOT analysis is provided on the use of WGS and metagenomics for Salmonella and Shigatoxin-producing Escherichia coli (STEC) serotyping and the identification of antimicrobial resistance determinants in bacteria. Close agreement between phenotypic and WGSbased genotyping data has been observed. WGS provides additional information on the nature and localisation of antimicrobial resistance determinants and on their dissemination potential by horizontal gene transfer, as well as on genes relating to virulence and biological fitness. Interoperable data will play a major role in the future use of WGS and metagenomic data. Capacity building based on harmonised, quality controlled operational systems within European laboratories and worldwide is essential for the investigation of cross-border outbreaks and for the development of international standardised risk assessments of food-borne microorganisms.

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Antibiotic resistance in European wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence

Cited by 371 publications

References 28 publications

Antibiotic resistant and extended-spectrum β-lactamase producing faecal coliforms in wastewater treatment plant effluent

Antibiotic resistant and extended-spectrum β-lactamase producing faecal coliforms in wastewater treatment plant effluent

The Contribution of Wastewater to the Transmission of Antimicrobial Resistance in the Environment: Implications of Mass Gathering Settings

Whole genome sequencing and metagenomics for outbreak investigation, source attribution and risk assessment of food‐borne microorganisms

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