Multidrug-resistant enterobacteriaceae in coastal water: an emerging threat

Abstract

Background The environmental role of carbapenemase-producing Enterobacteriaceae (CPE) acquisition and infection in human disease has been described but not thoroughly investigated. We aimed to assess the occurrence of CPE in nearshore aquatic bodies. Methods Enterobacteriaceae were cultured from coastal and estuary water near Netanya, Israel in June and July of 2018. Bacteria were identified by VITEK2® and their antimicrobial susceptibility was tested according to the CLSI guidelines. Enterobacteriaceae genomes were sequenced to elucidate their resistome and carbapenemase types. Results Among other clinically relevant bacteria, four CPE (three Enterobacter spp and one Escherichia coli isolate) were isolated from two river estuaries (Poleg and Alexander Rivers) and coastal water at a popular recreational beach (Beit Yanai). Molecular analysis and genome sequencing revealed the persistent presence of rare beta-lactamase resistance genes, including blaIMI-2 and a previously unknown blaIMI-20 allele, which were not found among the local epidemiological strains. Genome comparisons revealed the high identity of riverine and marine CPE that were cultivated one month apart. Conclusions We show that CPE contamination was widespread in nearshore marine and riverine habitats. The high genome-level similarity of riverine and marine CPEs, isolated one month apart, hints at the common source of infection. We discuss the clinical implications of these findings and stress the urgent need to assess the role of the aquatic environment in CPE epidemiology.

Presence of β-Lactamase-producing Enterobacterales and Salmonella Isolates in Marine Mammals

“…The Northeastern Pacific Ocean is a rich habitat that sustains a massive amount of phytoplankton, zooplankton, krill, and fish, all of which support a diverse and abundant community of more than 30 species of marine mammals [ 10 ]. Previous observations indicate that the marine environment may act as a reservoir of antimicrobial resistance genes [ 11 , 12 , 13 , 14 ]. Different mechanisms can lead to the presence of antimicrobial-resistant bacteria in the oceans: first, anthropogenic antimicrobial-containing runoff, challenging native bacteria to become resistant; second, coastal runoff of already resistant bacteria from terrestrial sources; and third—although less important in this context—antimicrobial production by marine microorganisms [ 11 , 15 ].…”

Carbapenem Resistance among Marine Bacteria—An Emerging Threat to the Global Health Sector

“…and E. coli carrying bla IMI-2 , were also isolated from river estuaries and beach water. Further molecular analysis and genome comparisons revealed the high similarity of these riverine and marine CRB from samples that were collected one month apart [77]. Thus, local sources, such as stormwaters and rivers, are an important source of CRB in the seawater and may have a significant effect on the composition of CRB in the marine environment (see Figure 1).…”

“…The dissemination of AR in seawater may be influenced by discharges from coastal runoff, aquaculture, polluted rivers, and WWTP effluents, which frequently contain resistant bacteria and resistant genes [72][73][74][75][76][77]. A study described that CRB communities in seawater and storm water samples did not differ significantly at the investigated sites, and the phylogenetic analysis showed that their CR isolates often belonged to the same species [25].…”

“…For example, CRGs, such as KPC, IMP, VIM, SPM, NDM, and OXA-carbapenemases, have been identified in E. coli, K. pneumoniae, Acinetobacter spp., Aeromonas spp., Enterobacter spp., and Pseudomonas spp. in recreational coastal waters of Rio de Janeiro [73,76], Israel [77], and Ireland [95]. This prevalence has public health implications [26,86], since coastal waters are frequently used for recreational and sport purposes.…”

“…VIM, SPM, NDM, and OXA-carbapenemases, have been identified in E. moniae, Acinetobacter spp., Aeromonas spp., Enterobacter spp., and Pseudomon reational coastal waters of Rio de Janeiro [73,76], Israel [77], and Ireland [95 This prevalence has public health implications [26,86], since coastal w quently used for recreational and sport purposes. CR infections can, in stances, be acquired through common routes of pathogen exposure to huma ingestion, inhalation, and dermal or eye contact with the beach waters [128 ure 2).…”