期刊
WATER RESEARCH
卷 200, 期 -, 页码 -出版社
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.watres.2021.117261
关键词
Wastewater epidemiology; CPE; Carbapenemase; Antibiotic resistance; Hospital sewage
资金
- Swedish Research Council FORMAS [2014-1575, 2018-00833]
- Region Vastra Gotaland under the ALF agreement [ALFGBG-428382, ALFGBG717901]
- center for Antibiotic Resistance Research at University of Gothenburg
- Adlerbert Research Foundation
- Formas [2018-00833] Funding Source: Formas
- Swedish Research Council [2018-00833] Funding Source: Swedish Research Council
Sewage monitoring shows promise and limitations as a complement to traditional clinical resistance surveillance for early warning of rare forms of resistance. Carbapenemase-producing Enterobacterales (CPE) detected in sewage were related to those found in patients, but there were also inconsistencies between the two sources.
Carbapenemase-producing Enterobacterales (CPE) constitute a significant threat to healthcare systems. Continuous surveillance is important for the management and early warning of these bacteria. Sewage monitoring has been suggested as a possible resource-efficient complement to traditional clinical surveillance. It should not least be suitable for rare forms of resistance since a single sewage sample contains bacteria from a large number of individuals. Here, the value of sewage monitoring in early warning of CPE was assessed at the Sahlgrenska University Hospital in Gothenburg, Sweden, a setting with low prevalence of CPE. Twenty composite hospital sewage samples were collected during a two-year period. Carbapenemase genes in the complex samples were analyzed by quantitative PCR and the CPE loads were assessed through cultures on CPE-selective agar followed by species determination as well as phenotypic and genotypic tests targeting carbapenemases of presumed CPE. The findings were related to CPE detected in hospitalized patients. A subset of CPE isolates from sewage and patients were subjected to whole genome sequencing. For three of the investigated carbapenemase genes, bla(NDM), bla(OXA-48-like) and bla(KPC), there was concordance between gene levels and abundance of corresponding CPE in sewage. For the other two analyzed genes, bla(VIM) and bla(IMP), there was no such concordance, most likely due to the presence of those genes in non-Enterobacterales populating the sewage samples. In line with the detection of OXA-48-like- and NDM-producing CPE in sewage, these were also the most commonly detected CPE in patients. NDM-producing CPE were detected on a single occasion in sewage and isolated strains were shown to match strains detected in a patient. A marked peak in CPE producing OXA-48-like enzymes was observed in sewage during a few months. When levels started to increase there were no known cases of such CPE at the hospital but soon after a few cases were detected in samples from patients. The OXA-48-like-producing CPE from sewage and patients represented different strains, but they carried similar bla(OXA-48-like)-harbouring mobile genetic elements. In conclusion, sewage analyses show both promise and limitations as a complement to traditional clinical resistance surveillance for early warning of rare forms of resistance. Further evaluation and careful interpretation are needed to fully assess the value of such a sewage monitoring system. (C) 2021 The Authors. Published by Elsevier Ltd.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据