Abstract

Antibiotic resistance presents a serious and still growing threat to human health. Environmental exposure levels required to select for resistance are unknown for most antibiotics. Here, we evaluated different experimental approaches and ways to interpret effect measures, in order to identify what concentration of trimethoprim that are likely to select for resistance in aquatic environments. When grown in complex biofilms, selection for resistant E. coli increased at 100 µg/L, whereas there was only a non-significant trend with regards to changes in taxonomic composition within the tested range (0–100 µg/L). Planktonic co-culturing of 149 different E. coli strains isolated from sewage again confirmed selection at 100 µg/L. Finally, pairwise competition experiments were performed with engineered E. coli strains carrying different trimethoprim resistance genes (dfr) and their sensitive counterparts. While strains with introduced resistance genes grew slower than the sensitive ones at 0 and 10 µg/L, a significant reduction in cost was found already at 10 µg/L. Defining lowest effect concentrations by comparing proportion of resistant strains to sensitive ones at the same time point, rather than to their initial ratios, will reflect the advantage a resistance factor can bring, while ignoring exposure-independent fitness costs. As costs are likely to be highly dependent on the specific environmental and genetic contexts, the former approach might be more suitable as a basis for defining exposure limits with the intention to prevent selection for resistance. Based on the present and other studies, we propose that 1 µg/L would be a reasonably protective exposure limit for trimethoprim in aquatic environments.

Highlights

  • Antibiotic resistance is a growing concern worldwide, resulting in a lack of effective treatment options for many patients (WHO, 2017)

  • Phenotypic resistance To identify the concentration of trimethoprim that selects for resistance in a complex bacterial community, a continuous flow-through system with growing biofilms was used

  • To the best of our knowledge, this is the first study that compares different exposure setups combined with different levels of culture complexity to investigate what antibiotic concentrations select for resistance

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Summary

Introduction

Antibiotic resistance is a growing concern worldwide, resulting in a lack of effective treatment options for many patients (WHO, 2017). For other bacteria, resistance rates are rising, despite reductions in prescriptions (Livermore, 2005). An intervention when trimethoprim prescription was reduced by 85% for a period of fourteen months in a region in southern Sweden did not have any positive impact on resistance rates in E. coli (Sundqvist et al, 2010). Trimethoprim resistance rates rose steadily from 2008 to 2014 in clinical E. coli isolates that cause uncomplicated urinary tract infec­ tions, both in Sweden (9–17%) and in the UK (13–46%) (Kahlmeter et al, 2015). A global consumption survey performed be­ tween 2000 and 2010 revealed that trimethoprim usage ranges among the five most used antibiotics worldwide (Van Boeckel et al, 2014), driving the increase of trimethoprim resistance

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