Multidrug Resistant Klebsiella pneumoniae ST101 Clone Survival Chain From Inpatients to Hospital Effluent After Chlorine Treatment

Abstract

In this paper we describe the transmission of a multi-drug resistant Klebsiella pneumoniae ST101 clone from hospital to wastewater and its persistence after chlorine treatment. Water samples from influents and effluents of the sewage tank of an infectious diseases hospital and clinical strains collected from the intra-hospital infections, during a period of 10 days prior to wastewater sampling were analyzed. Antibiotic resistant K. pneumoniae strains from wastewaters were recovered on selective media. Based on antibiotic susceptibility profiles and PCR analyses of antibiotic resistance (AR) genetic background, as well as whole-genome sequencing (Illumina MiSeq) and subsequent bioinformatic analyses, 11 ST101 K. pneumoniae strains isolated from hospital wastewater influent, wastewater effluent and clinical sector were identified as clonally related. The SNP and core genome analyses pointed out that five strains were found to be closely related (with ≤18 SNPs and identical cgMLST profile). The strains belonging to this clone harbored multiple acquired AR genes [blaCTX–M–15, blaOXA–48, blaOXA–1, blaSHV–106, blaTEM–150, aac(3)-IIa, aac(6′)-Ib-cr, oqxA10, oqxB17, fosA, catB3, dfrA14, tet(D)] and chromosomal mutations involved in AR (ΔmgrB, ΔompK35, amino acid substitutions in GyrA Ser83Tyr, Asp87Asn, ParC Ser80Tyr). Twenty-nine virulence genes involved in iron acquisition, biofilm and pili formation, adherence, and the type six secretion system – T6SS-III were identified. Our study proves the transmission of MDR K. pneumoniae from hospital to the hospital effluent and its persistence after the chlorine treatment, raising the risk of surface water contamination and further dissemination to different components of the trophic chain, including humans.

Ecology and Function of the Transmissible Locus of Stress Tolerance in Escherichia coli and Plant-Associated Enterobacteriaceae

“…The high proportion of tLST-positive clinical isolates of K. pneumoniae compared to that of K. pneumoniae isolates from other sources suggests that the tLST-mediated resistance to disinfection agents may facilitate persistence in hospitals. A tLST-positive K. pneumoniae isolate from a hospital chlorination tank influent was also resistant to 10 antibiotics ( 49 ). A pattern of higher frequency of the tLST in clinical isolates of C. sakazakii was not observed; however, 73.5% of genomes of clinical isolates of C. sakazakii clinical strains possessed the sHsp20 and clpK genes of the tLST, while only 24.3% of the environmental strains had these genes.…”

Fighting Antibiotic Resistance in Hospital-Acquired Infections: Current State and Emerging Technologies in Disease Prevention, Diagnostics and Therapy

“…Unfortunately, chemical agents can promote HGT in pathogens and thus contribute to AMR spread (Alotaibi et al, 2017;Lu and Guo, 2021). For example, hospital K. pneumoniae strains harboring numerous ARGs, can become tolerant to chlorine, and can then escape into environment through hospital wastewaters (Popa et al, 2020).…”

“…For example, hospital K . pneumoniae strains harboring numerous ARGs, can become tolerant to chlorine, and can then escape into environment through hospital wastewaters ( Popa et al, 2020 ).…”

ESBL Producing Escherichia coli in Faecal Sludge Treatment Plants: An Invisible Threat to Public Health in Rohingya Camps, Cox's Bazar, Bangladesh

“…Horizontal gene transfer may be facilitated by the high concentration and diversity of microbial flora of FSTPs via mobile genetic components like plasmids ( 21 , 22 ). It is alarming that, in many studies, the existence of an increasing ratio of ARB was reported both in raw sludge and effluent of the treatment plants in the case of urban sewage ( 23 – 25 ) as well as hospital effluents ( 26 , 27 ). However, apart from medicinal residues and ARGs, the main focus of faecal sludge recycling was on heavy metals, bacterial pathogens, and organic contaminants.…”