Wastewater-based monitoring reveals geospatial-temporal trends for antibiotic-resistant pathogens in a large urban community

Zillur Rahman; Weijia Liu; Lara Stapleton; Nikki Kenters; Dewa A P Rasmika Dewi; Ori Gudes; Helen Ziochos; Stuart J Khan; Kaye Power; Mary-Louise McLaws; Torsten Thomas

doi:10.1016/j.envpol.2023.121403

Wastewater-based monitoring reveals geospatial-temporal trends for antibiotic-resistant pathogens in a large urban community

Environ Pollut. 2023 May 15:325:121403. doi: 10.1016/j.envpol.2023.121403. Epub 2023 Mar 11.

Authors

Affiliations

¹ Centre for Marine Science and Innovation, School of Biological, Earth and Environmental Sciences, UNSW Sydney, Australia.
² School of Population Health, UNSW Sydney, Australia.
³ School of Population Health, UNSW Sydney, Australia; School of Built Environment, UNSW Sydney, Australia.
⁴ Department of Microbiology and Infectious Diseases, NSW Health Pathology, Liverpool, NSW, Australia.
⁵ UNSW Global Water Institute, UNSW Sydney, Australia; School of Civil and Environmental Engineering, UNSW Sydney, Australia.
⁶ Sydney Water, Parramatta, NSW, Australia.
⁷ School of Population Health, UNSW Sydney, Australia; UNSW Global Water Institute, UNSW Sydney, Australia.
⁸ Centre for Marine Science and Innovation, School of Biological, Earth and Environmental Sciences, UNSW Sydney, Australia. Electronic address: t.thomas@unsw.edu.au.

PMID: 36914152
DOI: 10.1016/j.envpol.2023.121403

Abstract

Antimicrobial resistance (AMR) is one of the top ten global health threats, and current surveillance programs rarely monitor it outside healthcare settings. This limits our ability to understand and manage the spread of AMR. Wastewater testing has the potential to simply, reliably and continuously survey trends in AMR outside the healthcare settings, as it captures biological material from the entire community. To establish and evaluate such a surveillance, we monitored wastewater for four clinically significant pathogens across the urban area of Greater Sydney, Australia. Untreated wastewater from 25 wastewater treatment plants (WWTPs) covering distinct catchment regions of 5.2 million residents was sampled between 2017 and 2019. Isolates for extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL-E) were consistently detected, suggesting its endemicity in the community. Isolates for carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) were only occasionally detected. The flow normalized relative (FNR) ESBL-E load was positively correlated with the proportion of the population between 19 and 50 years of age, completion of vocational education and the average length of hospital stay. Collectively, these variables explained only a third of the variance of the FNR ESBL-E load, indicating further, yet-unidentified factors as a contributor to the distribution. About half of the variation in the FNR CRE load was explained by the average length of hospital stay, showing healthcare-related drivers. Interestingly, variation in the FNR VRE load was not correlated to healthcare-related parameters but to the number of schools per 10,000 population. Our study provides insight into how routine wastewater surveillance can be used to understand the factors driving the distribution of AMR in an urban community. Such information can help to manage and mitigate the emergence and spread of AMR in important human pathogens.

Keywords: Antimicrobial resistance; Community; Correlation; Endemic; Geographic information system; Priority pathogens.

MeSH terms

Anti-Bacterial Agents*
Enterobacteriaceae
Humans
Methicillin-Resistant Staphylococcus aureus*
Wastewater
Wastewater-Based Epidemiological Monitoring
beta-Lactamases

Substances

Anti-Bacterial Agents
Wastewater
beta-Lactamases