Frequency and diversity of carbapenemase-producing Enterobacterales recovered from untreated wastewater impacted by selective media containing cefotaxime and meropenem in Ohio, USA

As safe agents of last resort, carbapenems are reserved for the treatment of infections caused by multidrug-resistant organisms. The impact of beta-lactam antibiotics, cefotaxime, and meropenem on the frequency and diversity of carbapenemase-producing organisms recovered from environmental samples has not been fully established. Therefore, this methodological study aimed at determining beta-lactam drugs used in selective enrichment and their impact on the recovery of carbapenemase-producing Enterobacterales (CPE) from untreated wastewater. We used a longitudinal study design where 1L wastewater samples were collected weekly from wastewater treatment plant (WWTP) influent and quarterly from contributing sanitary sewers in Columbus, Ohio USA with 52 total samples collected. Aliquots of 500 mL were passed through membrane filters of decreasing pore sizes to enable all the water to pass through and capture bacteria. For each sample, the resulting filters were placed into two modified MacConkey (MAC) broths, one supplemented with 0.5 mu g/mL of meropenem and 70 mu g/mL of ZnSO4 and the other supplemented with 2 mu g/mL cefotaxime. The inoculated broth was then incubated at 37 degrees C overnight, after which they were streaked onto two types of correspondingly-modified MAC agar plates supplemented with 0.5 mu g/mL and 1.0 mu g/mL of meropenem and 70 mu g/mL of ZnSO4 and incubated at 37 degrees C overnight. The isolates were identified based on morphological and biochemical characteristics. Then, up to four distinct colonies of each isolate's pure culture per sample were tested for carbapenemase production using the Carba-NP test. Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (MS) MALDI-TOF MS was used to identify carbapenemase-producing organisms. In total 391 Carba-NP positive isolates were recovered from the 52 wastewater samples: 305 (78%) isolates had bla(KPC), 73 (19%) carried bla(NDM), and 14 (4%) harbored both bla(KPC) and bla(NDM) resistance genes. CPE genes of both bla(KPC) and bla(NDM) were recovered in both types of modified MAC broths, with 84 (21%) having a bla(KPC) gene(,) 22 (6%) carrying bla(NDM) and 9 (2%) harbored both a bla(KPC) and bla(NDM) of isolates recovered from MAC medium incorporated with 0.5ug/mL meropenem and 70ug/mL ZnSO4. The most prevalent isolates were Klebsiella pneumoniae, Escherichia coli, and Citrobacter spp.

Automated summary

This study aimed to determine the impact of beta-lactam antibiotics on the recovery of carbapenemase-producing Enterobacterales from untreated wastewater. The results showed that there were a large number of carbapenemase-producing Enterobacterales in the untreated wastewater, with Klebsiella pneumoniae, Escherichia coli, and Citrobacter spp. being the most prevalent isolates.