Abstract
BackgroundThe environmental role of carbapenemase-producing Enterobacteriaceae (CPE) acquisition and infection in human disease has been described but not thoroughly investigated. We aimed to assess the occurrence of CPE in nearshore aquatic bodies.MethodsEnterobacteriaceae were cultured from coastal and estuary water near Netanya, Israel in June and July of 2018. Bacteria were identified by VITEK2® and their antimicrobial susceptibility was tested according to the CLSI guidelines. Enterobacteriaceae genomes were sequenced to elucidate their resistome and carbapenemase types.ResultsAmong other clinically relevant bacteria, four CPE (three Enterobacter spp and one Escherichia coli isolate) were isolated from two river estuaries (Poleg and Alexander Rivers) and coastal water at a popular recreational beach (Beit Yanai). Molecular analysis and genome sequencing revealed the persistent presence of rare beta-lactamase resistance genes, including blaIMI-2 and a previously unknown blaIMI-20 allele, which were not found among the local epidemiological strains. Genome comparisons revealed the high identity of riverine and marine CPE that were cultivated one month apart.ConclusionsWe show that CPE contamination was widespread in nearshore marine and riverine habitats. The high genome-level similarity of riverine and marine CPEs, isolated one month apart, hints at the common source of infection. We discuss the clinical implications of these findings and stress the urgent need to assess the role of the aquatic environment in CPE epidemiology.
Highlights
The environmental role of carbapenemase-producing Enterobacteriaceae (CPE) acquisition and infec‐ tion in human disease has been described but not thoroughly investigated
Water‐borne bacterial isolates Enterobacteriaceae, non-fermenter bacilli and Grampositive cocci were isolated from the coastal aquatic environment (Table 1)
Four strains of CPE were found in the two sampling sessions: three isolates of CP-Enterobacter spp and CP-Escherichia coli blaOXA-48
Summary
The environmental role of carbapenemase-producing Enterobacteriaceae (CPE) acquisition and infec‐ tion in human disease has been described but not thoroughly investigated. We aimed to assess the occurrence of CPE in nearshore aquatic bodies. Carbapenem-resistant Enterobacteriaceae (CRE), in particular, carbapenemase- and extended-spectrum β-lactamase-producing Enterobacteriaceae (CPE and ESBL-PE) endanger global health, as they have spread worldwide during the last two decades. Assessing the link between the clinical and aquatic epidemiology of CRE is often challenging. While some studies showed that clinical strains may be found in aquatic bodies [7, 9, 16], none such link was demonstrated in others [17, 20]
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