Water as a Source of Antimicrobial Resistance and Healthcare-Associated Infections

Abstract

Healthcare-associated infections (HAIs) are one of the most common patient complications, affecting 7% of patients in developed countries each year. The rise of antimicrobial resistant (AMR) bacteria has been identified as one of the biggest global health challenges, resulting in an estimated 23,000 deaths in the US annually. Environmental reservoirs for AMR bacteria such as bed rails, light switches and doorknobs have been identified in the past and addressed with infection prevention guidelines. However, water and water-related devices are often overlooked as potential sources of HAI outbreaks. This systematic review examines the role of water and water-related devices in the transmission of AMR bacteria responsible for HAIs, discussing common waterborne devices, pathogens, and surveillance strategies. AMR strains of previously described waterborne pathogens including Pseudomonas aeruginosa, Mycobacterium spp., and Legionella spp. were commonly isolated. However, methicillin-resistant Staphylococcus aureus and carbapenem-resistant Enterobacteriaceae that are not typically associated with water were also isolated. Biofilms were identified as a hot spot for the dissemination of genes responsible for survival functions. A limitation identified was a lack of consistency between environmental screening scope, isolation methodology, and antimicrobial resistance characterization. Broad universal environmental surveillance guidelines must be developed and adopted to monitor AMR pathogens, allowing prediction of future threats before waterborne infection outbreaks occur.

Wastewater depollution of textile dyes and antibiotics using unmodified and copper oxide/zinc oxide nanofunctionalised graphene oxide materials

“…11 Additionally, freely available antibiotic molecules in the water system have caused subsequent issues such as antimicrobial resistance (AMR) in waterborne pathogens. 12 These 'AMR superbugs' have potential to spread waterborne diseases that are difficult to detect and treat. 13 Existing wastewater treatment methods including traditional and biological methods to remove dyes and pharmaceuticals are inefficient, due to the persistent nature and nonbiodegradability of these contaminants.…”

“…11 Additionally, freely available antibiotic molecules in the water system have caused subsequent issues such as antimicrobial resistance (AMR) in waterborne pathogens. 12 These ‘AMR superbugs’ have potential to spread waterborne diseases that are difficult to detect and treat. 13…”

Evaluation of Multidrug-Resistant P. aeruginosa in Healthcare Facility Water Systems

“…It has been estimated that 20% of nosocomial pneumonias are caused by waterborne P. aeruginosa in the US, resulting in a conservative annual mortality of approximately 1400 individuals [ 28 ]. Ambrogi et al [ 22 ].…”

Legionellosis risk—an overview of Legionella spp. habitats in Europe

“…The role of water and common water-related devices also in the transmission of AMR bacteria responsible for HAIs is discussed recently since AMR strains of waterborne pathogens, including Legionella spp., are commonly isolated. Continuous monitoring of water systems and observation of changes in the resistance pattern is strongly recommended (Rahimi and Vesal 2017 ; Hayward et al 2020 ; Pappa et al 2020 ).…”