Surface water in Lower Saxony: A reservoir for multidrug-resistant Enterobacterales

Cansu Cimen; Janina Noster; Yvonne Stelzer; Andreas Rump; Janko Sattler; Matthijs Berends; Andreas Voss; Axel Hamprecht

doi:10.1016/j.onehlt.2023.100606

Surface water in Lower Saxony: A reservoir for multidrug-resistant Enterobacterales

One Health. 2023 Jul 27:17:100606. doi: 10.1016/j.onehlt.2023.100606. eCollection 2023 Dec.

Authors

Cansu Cimen^{1

2}, Janina Noster¹, Yvonne Stelzer¹, Andreas Rump³, Janko Sattler⁴, Matthijs Berends^{2

5}, Andreas Voss², Axel Hamprecht^{1

4}

Affiliations

¹ Institute for Medical Microbiology and Virology, University of Oldenburg, Oldenburg, Germany.
² University of Groningen, Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands.
³ University Institute for Medical Genetics, Klinikum Oldenburg, Oldenburg, Germany.
⁴ Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany.
⁵ Certe Medical Diagnostics and Advice Foundation, Department of Medical Epidemiology, Groningen, the Netherlands.

Abstract

The emergence of extended-spectrum β-lactamase and carbapenemase-producing Enterobacterales (ESBL-E and CPE, respectively) is a threat to modern medicine, as infections become increasingly difficult to treat. These bacteria have been detected in aquatic environments, which raises concerns about the potential spread of antibiotic resistance through water. Therefore, we investigated the occurrence of ESBL-E and CPE in surface water in Lower Saxony, Germany, using phenotypic and genotypic methods. Water samples were collected from two rivers, five water canals near farms, and 18 swimming lakes. ESBL-E and CPE were isolated from these samples using filters and selective agars. All isolates were analyzed by whole genome sequencing. Multidrug-resistant Enterobacterales were detected in 4/25 (16%) water bodies, including 1/2 rivers, 2/5 water canals and 1/18 lakes. Among all samples, isolates belonging to five different species/species complexes were detected: Escherichia coli (n = 10), Enterobacter cloacae complex (n = 4), Citrobacter freundii (n = 3), Citrobacter braakii (n = 2), and Klebsiella pneumoniae (n = 2). Of the 21 isolates, 13 (62%) were resistant at least to 3rd generation cephalosporins and eight (38%) additionally to carbapenems. CPE isolates harbored bla_KPC-2 (n = 5), bla_KPC-2 and bla_VIM-1 (n = 2), or bla_OXA-181 (n = 1); additionally, mcr-9 was detected in one isolate. Two out of eight CPE isolates were resistant to cefiderocol and two to colistin. Resistance to 3rd generation cephalosporins was mediated by ESBL (n = 10) or AmpC (n = 3). The presence of AmpC-producing Enterobacterales, ESBL-E and CPE in northern German surface water samples is alarming and highlights the importance of aquatic environments as a potential source of MDR bacteria.

Keywords: AmpC; Aquatic environment; CPE; ESBL-E; Whole genome sequencing; mcr-9.