Abstract
BackgroundAntibiotic-resistant bacteria (ARB) present a global public health problem. With numbers of community-acquired resistant infections increasing, understanding the mechanisms by which people are exposed to and colonised by ARB can help inform effective strategies to prevent their spread. The role natural environments play in this is poorly understood. This is the first study to combine surveillance of ARB in bathing waters, human exposure estimates and association between exposure and colonisation by ARB in water users. Methods97 bathing water samples from England and Wales were analysed for the proportion of E. coli harbouring blaCTX-M. These data were used to estimate the likelihood of water users ingesting blaCTX-M-bearing E. coli. Having identified surfers as being at risk of exposure to ARB, a cross-sectional study was conducted. Regular surfers and non-surfers were recruited to assess whether there is an association between surfing and gut colonisation by blaCTX-M-bearing E. coli. Results11 of 97 bathing waters sampled were found to contain blaCTX-M-bearing E. coli. While the percentage of blaCTX-M-bearing E. coli in bathing waters was low (0.07%), water users are at risk of ingesting these ARB. It is estimated that over 2.5 million water sports sessions occurred in 2015 resulting in the ingestion of at least one blaCTX-M-bearing E. coli. In the epidemiological survey, 9/143 (6.3%) surfers were colonised by blaCTX-M-bearing E. coli, as compared to 2/130 (1.5%) of non-surfers (risk ratio=4.09, 95% CI 1.02 to 16.4, p=0.046). ConclusionsSurfers are at risk of exposure to and colonisation by clinically important antibiotic-resistant E. coli in coastal waters. Further research must be done on the role natural environments play in the transmission of ARB.
Highlights
There is little doubt that the extensive anthropogenic use of antibiotics and antimicrobials has accelerated the emergence of antibiotic resistance among bacteria (Davies and Davies, 2010; Hawkey and Jones, 2009)
One group of Antibiotic-resistant bacteria (ARB) that is of special concern in human medicine are extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, which have been identified by the World Health Organization as being a Abbreviations: MGE, mobile genetic element; ARB, antibiotic resistant bacteria; ESBL, extended-spectrum beta-lactamase; blaCTX-M, beta lactamase cefotaximase-Munich; 3GCs, thirdgeneration cephalosporins; PCR, polymerase chain reaction; 95% confidence intervals (CI), 95% confidence interval; UTI, urinary tract infection; UK, United Kingdom
Escherichia coli harbouring blaCTX-M are present in coastal waters of England and Wales
Summary
There is little doubt that the extensive anthropogenic use of antibiotics and antimicrobials has accelerated the emergence of antibiotic resistance among bacteria (Davies and Davies, 2010; Hawkey and Jones, 2009). There are a number of different plasmid-borne ESBLs (including blaTEM and blaSHV), blaCTX-M genes represent nearly 80% of ESBLs in clinical isolates, with blaCTX-M-15 being the most common genotype found worldwide (Amos et al, 2014) Their prevalence is increasing outside healthcare settings (Amos et al, 2014; Hawkey and Jones, 2009). The rapid emergence and spread of ESBLs ( the CTXMs) poses a significant public health threat, as infections caused by ESBL-producing bacteria are unresponsive to multiple antibiotics, including essential frontline drugs such as third-generation cephalosporins (3GCs) (Collignon et al, 2009). The role natural environments play in this is poorly understood This is the first study to combine surveillance of ARB in bathing waters, human exposure estimates and association between exposure and colonisation by ARB in water users. Further research must be done on the role natural environments play in the transmission of ARB
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