Detection and genetic analysis of Escherichia coli from Tonle Sap Lake and its tributaries in Cambodia: Spatial distribution, seasonal variation, pathogenicity, and antimicrobial resistance

Recommendations of Key Elements within an Integrated Monitoring Framework of Antimicrobial Resistance for Asian Countries

“…10−12 Moreover, E. coli is the most studied bacterial species and has a rich genomic database, enabling the origin of AMR to be tracked through whole genome sequencing and multilocus sequence typing (MLST). 8,9,11,12 ■ HOW TO MONITOR The choice of cost-effective methods is critical for realistic monitoring implementation in resource-limited settings in LMICs. Culture-based methods are widely accepted, more feasible, and cost-effective in many LMICs than molecular methods for immediate implementation.…”

“…Where such facilities already exist, molecular-based methods could supplement more routine culture-based AMR monitoring and provide a better understanding of the sources, diversity, and development of AMR in the environment. 8,9,11,12…”

“…The selection of monitoring locations and sampling frequency depends on the local needs and purposes, such as consideration of key sources of AMR, public health risk in exposure to AMR in contaminated water, and seasonal changes in AMR transport. In Asian low-resource LMICs, we suggest that rivers offer efficient nationwide monitoring opportunities, covering large areas with contributions from a variety of sources. − Source apportionment of the diversity and transfer of AMR can be achieved by selecting specific monitoring locations near point and nonpoint sources and identifying hot spots. The frequency of sampling often involves a trade-off with the number of monitoring locations under limited-resource settings.…”

“…Priority locations for monitoring stations include untreated wastewater discharges into rivers (e.g., from households, hospitals, and the livestock industry), particularly in populated urban areas and tourist spots. AMR in wastewater can also be monitored at wastewater treatment plants or in urban open drainage and canals if wastewater is not collected by sewer pipelines. − Other monitoring sites should consider the discharge of AMR from nonpoint sources (e.g., agriculture land where biosolids are applied or irrigated with wastewater). Monitoring of AMR in potable source waters could also be prioritized when immediate risks are identified in vulnerable areas.…”

“…For targeted microbes, we propose Escherichia coli as a strong monitoring candidate. Due to the frequent detection of E. coli and antimicrobially resistant E. coli in various environmental matrices in Asian countries, − the WHO proposed extended-spectrum β-lactamase (ESBL)-producing E. coli as a primary indicator of AMR in the tricycle protocol. In addition, because E. coli is used as a fecal contamination indicator in aquatic environments, the presence of antimicrobially resistant E. coli indicates the spread of AMR from human and animal sources. − Moreover, E. coli is the most studied bacterial species and has a rich genomic database, enabling the origin of AMR to be tracked through whole genome sequencing and multilocus sequence typing (MLST). ,,, …”