Related carbapenemase-producing Klebsiella isolates detected in both a hospital and associated aquatic environment in Sweden

Abstract

Carbapenem antibiotics are one of the last-resort agents against multidrug-resistant (MDR) bacteria. The occurrence of carbapenemase-producing Enterobacteriaceae (CPE) in wastewater and aquatic environments is an indication of MDR bacteria in the community. This study evaluated CPE in aquatic environments and compared them to the local hospital isolates in Sweden. Phenotypic and genotypic analyses of antibiotic resistance of environmental and clinical CPE were performed. The relatedness of the isolates and possible clonal dissemination was evaluated using phylogenetic and phyloproteomic analysis. Klebsiella oxytoca carrying carbapenemase genes (bla, bla) were isolated from wastewater and the recipient river, while K. oxytoca (bla) and Klebsiella pneumoniae (bla, bla, bla, bla) were isolated from patients at the local clinics or hospital. The K. oxytoca classified as sequence type 172 (ST172) isolated from the river was genotypically related to two clinical isolates recovered from patients. The similarity between environmental and clinical isolates suggests the dispersion of bla producing K. oxytoca ST172 from hospital to aquatic environment and the likelihood of its presence in the community. This is the first report of CPE in aquatic environments in Sweden; therefore, surveillance of aquatic and hospital environments for CPE in other urban areas is important to determine the major transfer routes in order to formulate strategies to prevent the spread of MDR bacteria.

Could honey bees signal the spread of antimicrobial resistance in the environment?

“…K. pneumoniae and K. oxytoca are the most medically important species of the genus with outbreaks of nosocomial infections in humans most frequently involving environmental sources (Lowe et al 2012). Among the eight K. oxytoca isolated in the present study, four were resistant to amoxicillin/clavulanic acid; this datum is not surprising since resistance of K. oxytoca to AMC and to other ß‐lactam drugs is largely described (Tsakris et al 2011; Lowe et al 2012; Khan et al 2018).…”

Whole genome sequencing snapshot of multi-drug resistant Klebsiella pneumoniae strains from hospitals and receiving wastewater treatment plants in Southern Romania

“…However, the epidemiology of resistant K. pneumoniae clinical strains in WWTPs in Romania is currently unknown. Moreover, K. pneumoniae is a good indicator of the transmission between clinical and environmental AR reservoirs, being an ubiquitous microorganism found in soil, surface water and on plants [8], but also one of the most important Gram-negative opportunistic pathogens, frequently associated with both hospital and community acquired severe infections. [9,10]; Moreover, K. pneumoniae could cumulate resistance (e.g.…”

Environmental Presence and Genetic Characteristics of Carbapenemase-Producing Enterobacteriaceae from Hospital Sewage and River Water in the Philippines

“…Antibiotic resistance has traditionally been viewed as a clinical problem, but within the last decade, natural ecosystems have been recognized as important reservoirs of antibiotic resistance genes (8). CPE have been reported in the natural environment (9), and previous studies have reported the presence of carbapenemase-and/or extendedspectrum ␤-lactamase-producing Enterobacteriaceae in rivers, effluent, and hospital sewage systems worldwide (10)(11)(12), highlighting the interrelationship between human infection and water sources (13). It can thus be inferred that the primary origin of these bacteria is humans, from clinical settings and community settings, and that these bacteria are disseminated to the environment.…”