Enterobacteriaceae Isolated from the River Danube: Antibiotic Resistances, with a Focus on the Presence of ESBL and Carbapenemases

Abstract

In a clinical setting it seems to be normal these days that a relevant proportion or even the majority of different bacterial species has already one or more acquired antibiotic resistances. Unfortunately, the overuse of antibiotics for livestock breeding and medicine has also altered the wild-type resistance profiles of many bacterial species in different environmental settings. As a matter of fact, getting in contact with resistant bacteria is no longer restricted to hospitals. Beside food and food production, the aquatic environment might also play an important role as reservoir and carrier. The aim of this study was the assessment of the resistance patterns of Escherichia coli and Klebsiella spp. out of surface water without prior enrichment and under non-selective culture conditions (for antibiotic resistance). In addition, the presence of clinically important extended spectrum beta lactamase (ESBL) and carbapenmase harboring Enterobacteriaceae should be investigated. During Joint Danube Survey 3 (2013), water samples were taken over the total course of the River Danube. Resistance testing was performed for 21 different antibiotics. Samples were additionally screened for ESBL or carbapenmase harboring Enterobacteriaceae. 39% of all isolated Escherichia coli and 15% of all Klebsiella spp. from the river Danube had at least one acquired resistance. Resistance was found against all tested antibiotics except tigecycline. Taking a look on the whole stretch of the River Danube the proportion of multiresistances did not differ significantly. In total, 35 ESBL harboring Enterobacteriaceae, 17 Escherichia coli, 13 Klebsiella pneumoniae and five Enterobacter spp. were isolated. One Klebsiella pneumoniae harboring NMD-1 carbapenmases and two Enterobacteriaceae with KPC-2 could be identified. Human generated antibiotic resistance is very common in E. coli and Klebsiella spp. in the River Danube. Even isolates with resistance patterns normally associated with intensive care units are present.

High prevalence of faecal carriage of ESBL-producing Enterobacteriaceae in Norwegian patients with gastroenteritis

“…, the Netherlands(85), the UK(90), from the river Danub(87), and in migrating penguins(125). The presence of ESBL-EC ST10 in different water and wastewater sources on different dates, calls for further investigation of the dissemination of this strain in other ecological niches in Norway, such as farm animals, manure, birds and wild animals.…”

Multidrug-Resistant Enterobacteriaceae in Coastal Water: An Emerging Threat

“…understood. Yet, cultivation-based studies demonstrate that common gut bacteria, such as Enterobacteriaceae, are frequently detected in freshwater (8,10,11,15,51,52) and seawater(5-7). These bacteria may be able to cope with different salinities because the human gut environment is characterized by spatial and temporal heterogeneity in osmolarity, based on the kinds of meals consumed(53).…”

“…Recent studies show that CRE may contaminate aquatic environments such as marine surface water(4-7), rivers (5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), estuaries (18) and polluted drinking water (19). Riverine CRE often harbor several carbapenemase types [9,31] (8,10,11,15). A case of bla IMI-2 CP-Enterobacter asburiae bacteremia following a river near-drowning accident was described, and the infecting pathogen was isolated from the river one month later (16).…”

Untreated wastewater as a source of carbapenem-resistant bacteria to the riverine ecosystem

“…There have been several reports of bacteria with acquired carbapenem resistance isolated from hospital wastewaters (Ferreira et al, 2011;Zhang et al, 2012;Zhang et al, 2013;Chandran et al, 2014;Seruga Music et al, 2017), as well as raw and secondary treated municipal wastewaters (Hrenovic et al, 2016;Hrenovic et al, 2017a,b). Regarding the natural aquatic environment, in the Danube River during the Joint Danube Survey 3 in 2013 one carbapenem-resistant Klebsiella pneumoniae and two other Enterobacteriaceae were reported (Kittinger et al, 2016). Additionally, one carbapenem-resistant isolate of A. baumannii was found in the Seine River (Gihrlich et al, 2010) and four in the Sava River (Seruga Music et al, 2017).…”