Abstract
Extended spectrum β-lactamase producing Escherichia coli (ESBL-EC) are excreted via effluents and sewage into the environment where they can re-contaminate humans and animals. The aim of this observational study was to detect and quantify ESBL-EC in recreational water and wastewater, and perform a genetic and phenotypic comparative analysis of the environmental strains with geographically associated human urinary ESBL-EC. Recreational fresh- and saltwater samples from four different beaches and wastewater samples from a nearby sewage plant were filtered and cultured on differential and ESBL-selective media. After antimicrobial susceptibility testing and multi-locus variable number of tandem repeats assay (MLVA), selected ESBL-EC strains from recreational water were characterized by whole genome sequencing (WGS) and compared to wastewater and human urine isolates from people living in the same area. We detected ESBL-EC in recreational water samples on 8/20 occasions (40%), representing all sites. The ratio of ESBL-EC to total number of E. coli colony forming units varied from 0 to 3.8%. ESBL-EC were present in all wastewater samples in ratios of 0.56–0.75%. ST131 was most prevalent in urine and wastewater samples, while ST10 dominated in water samples. Eight STs and identical ESBL-EC MLVA-types were detected in all compartments. Clinical ESBL-EC isolates were more likely to be multidrug-resistant (p<0.001).This study confirms that ESBL-EC, including those that are capable of causing human infection, are present in recreational waters where there is a potential for human exposure and subsequent gut colonisation and infection in bathers. Multidrug-resistant E. coli strains are present in urban aquatic environments even in countries where antibiotic consumption in both humans and animals is highly restricted.
Highlights
Antimicrobial resistance (AMR) is an increasing worldwide problem that affects both humans and animals
Eight out of 20 recreational water samples (40%) contained ESBL-EC, and ESBL-EC were present at all sampling sites in an average concentration of 0.76 colony forming units (CFUs)/100 ml
Antibiotic susceptibility testing (AST) and multi-locus variable number of tandem repeats assay (MLVA) were performed on all isolates from recreational water (N = 167) (S1 Table), and 82 unique isolates were selected for whole genome sequencing (WGS) (Fig 1)
Summary
Antimicrobial resistance (AMR) is an increasing worldwide problem that affects both humans and animals. The fear that a post-antibiotic era is approaching enforces us to embrace the One Health perspective, in the recognition that human health is closely related to the health of animals and to the environment [1, 2]. In the Scandinavian countries, ESBL-EC is an increasing problem in human medicine, and their presence has been described in domesticated animals and livestock [17,18,19,20,21], as well as in the red fox [22], in gulls [6], and in potable water [11]
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