Multidrug-resistant enterobacteriaceae in coastal water: an emerging threat
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(2020) 9:169
Open Access
RESEARCH
Multidrug‑resistant enterobacteriaceae in coastal water: an emerging threat Regev Cohen1,2* , Svetlana Paikin1, Assaf Rokney3, Maxim Rubin‑Blum4 and Peleg Astrahan5
Abstract Background: The environmental role of carbapenemase-producing Enterobacteriaceae (CPE) acquisition and infec‑ tion 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 culti‑ vated 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 infec‑ tion. We discuss the clinical implications of these findings and stress the urgent need to assess the role of the aquatic environment in CPE epidemiology. Keyword: Carbapenemase producing enterobacteriaceae (CPE), Seawater, Estuary, Israel, Public health, Enterobacter spp. Background Carbapenem-resistant Enterobacteriaceae (CRE), in particular, carbapenemase- and extended-spectrum β-lactamase-producing Enterobacteriaceae (CPE and ESBL-PE) endanger global health, as they have spread worldwide during the last two decades. The risk factors for the acquisition of these multidrug-resistant organisms (MDROs) are usually associated with healthcare [1] and overseas travel [2]. Potential modes of environmental *Correspondence: [email protected]; [email protected] 1 Head of Infectious Diseases and Infection Control Units, Sanz Medical Center, Laniado Hospital, 16 Divrei Haim St, Kiryat Sanz, 42150 Netnaya, Israel Full list of author information is available at the end of the article
transmission of these bacteria to humans outside of healthcare facilities following exposure to wildlife, livestock and pet animals have been reported [3]. The environmental routes of CRE infection may play a role in causing human disease and spreading it globally, however, they have not been thoroughly investigated yet. In particular, little is known about the epidemiology of CRE in the aquatic environment. Recent studies show that CRE
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