Antibiotic resistance in wastewater from socio-spatially different communities

Abstract

Abstract Antibiotic resistance (ABR) and the spread of multidrug-resistant organisms (MDRO) via wastewater are of global health concern. Simultaneously, wastewater-based surveillance is a promising approach to gain an overview of the local ABR situation providing complementary public health data at lower costs. Research on the general community as one of the biggest dischargers is rather scarce. The objective of this study was to explore spatial and temporal differences in the occurrence of MDRO in community wastewater from socio-spatially different districts. Wastewater from three socio-spatially different districts in the Ruhr Metropolis, Germany, was sampled monthly over a year and analysed for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli via culture-based methods. Isolates were validated with matrix assisted laser desorption ionization time of flight mass spectrometry. Antibiotic resistance profiles were analysed via microdilution. Phenotypic ESBL-producing E. coli could be isolated from every wastewater sample. The socio-spatially disadvantaged area displayed higher ESBL-producing E. coli loads adjusted for domestic discharge and inhabitants (median: 3.8e+8 CFU/d/inh.) compared to the other two areas (socio-spatially advantaged: 1.5e+8 CFU/d/inh. and socio-spatial average: 2.0e+8 CFU/d/inh.). Aggregated into seasons, values were highest for the winter season. Resistance profiles varied only for those antibiotics, which can be administered in outpatient care, showing lower resistance levels in the socio-spatially advantaged area. The general community is an important contributor of ESBL-producing E. coli in wastewater. Spatial and seasonal influences of ESBL-producing E. coli in wastewater between different communities, depicting the human outpatient sector, are identifiable and suggest a higher ABR burden in a socio-spatially disadvantaged area and during the winter season, as well as lower resistance levels in a socio-spatially advantaged area. Key messages The general community is a relevant source of multidrug-resistant bacteria in wastewater with observable spatial and seasonal influences between socio-spatially different communities. Findings suggest small-scale differences with a higher antibiotic resistance burden in a socio-spatially disadvantaged area and lower resistance levels in a socio-spatially advantaged area.