A-Z Index × Submit A-Z Index × Submit A-Z Index Search Dropdown × Submit Facebook Twitter LinkedIn Syndicate Emerging Infectious Disease journal ISSN: 1080-6059 Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
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Carbapenem resistance in bacteria is an urgent public health threat. Wastewater surveillance could support antimicrobial resistance monitoring at long-term care facilities. We assessed feasibility of wastewater sampling at such facilities for carbapenemase genes ( bla KPC , bla VIM , bla OXA-48-like , bla NDM , and bla IMP ) detected by quantitative PCR or GeneXpert Carba-R (Cepheid, https://www.cepheid.com ) over 16 months and compared those findings with those for clinical infections. The bla KPC , bla OXA-48-like , and bla VIM genes were routinely detected in composite wastewater samples, passive samples, and sewer biofilm swab specimens. Wastewater and sewer biofilm resistomes differed, but both contained bla KPC, bla VIM, and bla IMP . Wastewater surveillance for carbapenemases shows promise, but few clinical infections during the study period and contributions from sewer biofilms complicate correlations between wastewater measurements and clinical incidence, underscoring the need for further research.
Antimicrobial-resistant infections caused >35,000 deaths in the United States ( 1 ) and 1,270,000 deaths worldwide ( 2 ) in 2017; US costs exceeded $13.5 billion ( 1 ). By 2050, antimicrobial resistance (AMR)–related deaths are projected to rise by 70%, to >208 million ( 3 ). Among the Centers for Disease Control and Prevention–classified urgent threats are carbapenem-resistant Enterobacterales (CRE), which are responsible for ≈13,100 hospital-associated infections in the United States annually ( 1 ). Intermediate and long-term acute care facilities are particularly vulnerable to CRE because of high transmission risk and limited treatment options for antimicrobial-resistant infections ( 4 ).
Routine patient surveillance for infection and colonization by antimicrobial-resistant pathogens is costly ( 5 ) and invasive ( 6 ), whereas monitoring hospital wastewater offers a nonnvasive, cost-effective alternative ( 7 , 8 ) that captures signals of AMR from large patient populations, including colonized persons. Multiple studies have attempted to correlate wastewater AMR genes with infections or hospitalizations in associated communities ( 9 – 11 ), although few were longitudinal studies ( 12 – 14 ). One notable study detected a bla NDM -producing CRE in hospital wastewater that matched a patient isolate ( 12 ), whereas another found bla CTX-M wastewater concentrations were reflective of the patient population ( 11 ).
Carbapenem-resistant infections are a growing threat in healthcare settings, highlighting the need for practical surveillance methods to detect outbreaks early. Wastewater surveillance might be such a solution, although sampling techniques might influence wastewater gene concentrations. To address those concerns, we monitored 5 carbapenemase genes of clinical concern ( bla KPC , bla VIM , bla OXA-48-like , bla NDM , and bla IMP ) ( 15 ) in wastewater from a rehabilitation hospital over 16 months. We collected samples weekly, twice weekly, or monthly using composite, passive, and biofilm-based methods and analyzed them by quantitative PCR (qPCR),…