Monitoring Carbapenem-Resistant Enterobacterales in the Environment to Assess the Spread in the Community
ABSTRACT; Taro Urase, Saki Goto, Mio Sato. Antibiotics. 11(7):917, 2022. (DOI)
The usefulness of wastewater-based epidemiology (WBE) was proven during the COVID-19 pandemic, and the role of environmental monitoring of emerging infectious diseases has been recognized. In this study, the prevalence of carbapenem-resistant Enterobacterales (CRE) in Japanese environmental samples was measured in the context of applying WBE to CRE. A total of 247 carbapenem-resistant isolates were obtained from wastewater, treated wastewater, and river water. Treated wastewater was shown to be an efficient target for monitoring CRE. The results of the isolate analysis showed that WBE may be applicable to Escherichia coli-carrying New Delhi metallo-β-lactamase (NDM)-type carbapenemase, the Enterobacter cloacae complex and Klebsiella pneumoniae complex-carrying IMP-type carbapenemase. In addition, a certain number of CRE isolated in this study carried Guiana extended spectrum (GES)-type carbapenemase although their clinical importance was unclear. Only a few isolates of Klebsiella aerogenes were obtained from environmental samples in spite of their frequent detection in clinical isolates. Neither the KPC-type, the oxacillinase (OXA)-type nor the VIM-type of carbapenemase was detected in the CRE, which reflected a low regional prevalence. These results indicated the expectation and the limitation of applying WBE to CRE.
Prevalence of ESBL-producing Escherichia coli and carbapenem-resistant Enterobacteriaceae in treated wastewater: a comparison with nosocomial infection surveillance
ABSTRACT; Taro Urase, Mitsuhiro Okazaki, Hirofumi Tsutsui. J. of Water and Health, 18, 6, 899-910, 2020. DOI: https://doi.org/10.2166/wh.2020.014
The increasing prevalence of extended spectrum β-lactamase (ESBL)-producing E. coli and carbapenem-resistant Enterobacteriaceae (CRE) is a worldwide health threat. Monitoring of these resistant bacteria in the environment can provide regional prevalence reflecting both healthy and infected population, although the quantitative monitoring of those resistant bacteria especially CRE is difficult due to their low proportion in the total Enterobacteriaceae population and the possible interference by autochthonous species with intrinsic resistance. In this study, these resistant bacteria in treated wastewater were quantified at 12 different treatment plants. The proportions of CTX-resistant and ESBL-producing E. coli in the total E. coli population in the chlorinated effluents in Tokyo were 5.7% and 5.3%, respectively. The estimated proportion of CRE was 0.007% with the constituting species of Klebsiella spp. and Enterobacter spp., although the conditions during the first incubation may have affected the estimation even after the correction by the proportion of resistant population in the isolates. The observed resistant proportions in this study were lower than those in the surveillance on nosocomial infection not only for inpatients but for outpatients, and higher than those in the veterinary monitoring.
Characterization of Extended Spectrum β-lactamase-producing Escherichia coli in the Environment Isolated with Different Concentrations of Cefotaxime
ABSTRACT; Hirofumi Tsutsui, Taro Urase. J. of Water and Environment Technology, Vol. 17, No. 4, pp.262-271, 2019. DOI: 10.2965/jwet.18-091
Wastewater treatment plays an important role in controlling the release of antimicrobial resistant bacteria to the environment. We characterized extended spectrum β-lactamase (ESBL)-producing Escherichia coli strains isolated from the environment by cefotaxime (CTX)-containing agar plates in this study. The results on the samples under the influence of treated wastewater showed that 1.2% to 5.3% of the total E. coli population formed colonies on the ECC medium containing 4 µg/mL CTX and all of them were ESBL-producing strains. Addition of 4 µg/mL CTX to the ECC medium imposed a selection pressure equivalent to MIC higher than 64 µg/mL (MIC breakpoint in the previous Clinical and Laboratory Standards Institute [CLSI] criteria) because the medium containing CTX not only inhibited the growth of the strains with lower MICs than the concentration in the medium but also suppressed the formation of colonies of the strains with higher MICs. Adding 64 µg/mL CTX in the ECC medium selected only clinically important strains with an intensively resistant spectrum covering cephalosporins (including ceftazidime) and fluoroquinolones. Some isolates harbored multiple ESBL-producing genes. The dominant genes encoding ESBL were blaCTX-M group 1, blaCTX-M group 9, and blaTEM group.
Quantitative monitoring of resistance in Escherichia coli to clinically important antimicrobials in an urban watershed
ABSTRACT; Taro URASE, Takaya SATO. J. of Water and Environment Technology, Vol. 14, No. 5, pp.341-349, 2016. DOI: 10.2965/jwet.16-002
The resistance in Escherichia coli to clinically important antimicrobial agents including fluoroquinolones and third-generation cephalosporins was investigated in the Tama river watershed to obtain the regional prevalence of the resistance to the newer antimicrobials. Among a total of 3629 isolates, 78 strains (2.1%) were resistant to cefotaxime (probable extended-spectrum beta-lactamases producers) and 76 isolates were resistant to levofloxacin, although no carbapenem-resistant strains were found. A high occurrence of the multiple resistant bacteria to different classes of newer antimicrobials was seen. The gap in the resistant ratio on the boundary between the mountainous area and urbanized area suggests that the antimicrobial resistance is a more sensitive indicator for fecal contamination than the density of E. coli. The resistant ratios of the environmental samples taken even at the middle to downstream in the watershed were lower than those of clinical isolates reported in a nationwide monitoring.
Keywords; antimicrobial resistance, Escherichia coli, third-generation cephalosporins, fluoroquinolones.
Profile of antibiotic resistance of Escherichia coli isolated from different water environments
ABSTRACT; Syo TERADA, Hidemi MIYAKE, and Taro URASE. J. of Japan Society on Water Environment, 35, 5, 73-80, 2012.
The incidence and the profile of resistance to antibiotics were examined for Escherichia coli isolated from different water environments. Strains of the bacterium isolated from a stream in a mountain area showed relatively simple profiles of resistance to only one antibiotic. Those isolated from treated wastewater showed a profile of simultaneous resistance to various antibiotics including cephalosporins of latter generation, new quinolones, and aminoglycosides, which are intensively used in human therapy. Strains isolated from the Tama River on clear days showed similar characteristics to those isolated from treated wastewater, while a considerable number of those isolated on rainy days were resistant to tetracycline, possibly linked to the effect of livestock farming. The incidence of resistances to cephalosporins of different generation was dependent on origin of the samples.
Keywords; antibiotic resistance; water environments; Escherichia coli; treated wastewater.